First Aid Services and Practice Dr Nik Nor Ronaidi bin Nik Mahdi
Content• Introduction• Definition• Legal Provision• Establishing first aid facilities and services• Components of workplace first aid facilities – First aiders – First aid box – First aid room• Special first-aid requirements• Worker Awareness
Introduction• In US, there were 5,703 work-related fatalities in private industry in 2004.• In that same year there were 4.3 million total workplace injuries and illnesses, of which 1.3 million resulted in days away from work.• Occupational illnesses, injuries and fatalities in 2004 cost the United States’ economy $142.2 billion. The average cost per occupational fatality exceeded one million dollars.
Introduction• Sudden cardiac arrest (SCA) may occur at work.• According to recent statistics from the American Heart Association, there are 250,000 out-of-hospital SCAs annually.• Possible causes of SCA at workplace: – Electrocution – Exposure to low oxygen environments – Overexertion at work can also trigger SCA in those with underlying heart disease.• The outcome of occupational illnesses and injuries depends on the severity of the injury, available first-aid care and medical treatment.• Prompt, properly administered first aid may mean the difference between rapid or prolonged recovery, temporary or permanent disability, and even life or death.
Introduction• The aims of first aid are to: – Preserve life; – Prevent illness or injury from becoming worse; – Reduce pain; – Promote recovery; and – Care of unconscious.• First-aid is not just for serious injuries. It is also important for minor injuries such as burns, sprains, cuts, etc.
DefinitionsFirst aid:• the assessment and interventions that can be performed by a first aider during an emergency with minimal equipment until appropriate medical personnel arrive. (DOSH Guidelines)• emergency care provided for injury or sudden illness before emergency medical treatment is available. (US OSHA)
Definitions• First-aid in the workplace includes the provision of first-aid facilities, services and personnel required for the initial treatment of persons suffering from injury or illness at a workplace.• First-aid facilities includes: – first-aid box; – first-aid room; and – first-aid equipment, e.g. oxygen tanks and stretchers.
DefinitionsFirst-aider:• a person who has successfully completed a first-aid course and has been awarded with a certificate of proficiency in first-aid by a recognized institution (DOSH guidelines)
Legal Provision• An employer has a duty to provide information, instruction, training and supervision about first aid facilities and services for employees.The Factories and Machinery Act 1967• Section 25 (Parent Act) and Regulation 38 (Safety, Health and Welfare) state the scope of responsibility of an occupier with regards to first-aid provision: – provide and maintain a readily accessible first-aid box or cupboard – assign responsibility who must be proficient in first aid training if > 20 person employee – providing and maintaining a first-aid room in a factory where more than 150 person are employed.
Legal ProvisionThe Occupational Safety and Health Act 1994• Section 15(1) of the OSHA 1994 (Act 514) provides that every employer and the self-employed person must ensure, so far as is practicable, the safety, health and welfare at work of all his employees.• The provision of first-aid facilities and first-aiders is in compliance with the welfare component of this general duty of employers and self-employed persons.
Establishing first aid facilities and services
Establishing first aid facilities and services• The provision of first aid facilities and services starts with identifying all the hazards in the work environment that could lead to injury or harm to the health of people at the workplace.• This should be done in consultation with workers and their elected safety and health representatives, where they exist.• An assessment of the likelihood and consequences of the hazard leading to injury or harm will assist in identifying the means of reducing risk to the employees and the first aid services and facilities appropriate for the workplace.
Establishing first aid facilities and services• It is important to give consideration to high risk environments, such as: – Workplaces that use or manufacture hazardous substances – Construction and demolition sites – Timber harvesting sites – Workplaces where hazardous processes may be used (e.g. abrasive blasting) – Where heat is used as part of any process (e.g. moulding or casting, welding and cutting) – Where people are required to work in any remote or isolated areas (e.g. agricultural, fishing or transport industry) – Workplaces that provide assistance and care to highly dependant people
• The following matters need to be determined: – The contents of first aid boxes – The number of first aid boxes and where the boxes should be located ensuring they will be readily available – Any need for a simple oxygen supply – The number of people to be trained in first aid and what is approved training for the particular workplace – The possible need for a first aid room and the requirement it should contain – A system for recording and reporting – The availability of trained first aid personnel during working hours – The availability of professional medical care (e.g. hospital, medical centre) and emergency service (e.g. ambulance) response time
Components of workplace first aid facilitiesMajor Components:• first-aider• first-aid box• first-aid room• first-aid equipmentFactors to be considered in implementation:• type of industry / hazards• number of workers• number of work shifts• location of workplace and status of infrastructure in relation to the nearest medical clinic or hospital
First AiderProvision of Information About First-Aiders• An employer should display a notice, in a prominent place in the work-site, of the names and locations of first-aiders.• First-aiders should also be provided with a form of identification (e.g. badge, arm band) for easy recognition.Selection criteria:• Mature, responsible• physically fit• free from blood borne infectious diseases, e.g. Hepatitis B, HIV/AIDS• Calm in emergency, free to leave their work immediately to respond to an emergency
First AiderTraining• Recognized first aid course: – Basic life support – First Aid / Basic Trauma Life Support• Refresher Training → once every three (3) years.• The skills and knowledge of First Aiders should include the ability to: – undertake the initial treatment of injuries and illnesses occurring in the workplace – know when to call on the assistance of the emergency services or, where available, workplace medical practitioners or workplace nurses – follow the advice and direction of the emergency services – undertake CPR – utilize standard precautions to minimize the spread of infectious diseases when treating wounds and disposing of clinical waste – dispose of waste appropriately – maintain first aid kits and first aid rooms (if applicable) – record details of first aid treatment given – make appropriate reports to management.
First AiderResponsibilities• Management of Casualty – give immediate first-aid treatment – arrange without delay for the injured worker(s) to be sent to a doctor, hospital or home, according to the seriousness of this condition. – Apply the principle of Universal Precautions while delivering the responsibility to protect the first-aiders from acquiring blood borne pathogen e.g. Hepatitis B and HIV.• Maintenance of Treatment Record• Responsibilities for Maintenance of First-Aid Requirement
First Aider• The number of First Aiders are depending on: – the size and layout of the workplace – the location of the workplace – the number and distribution of employees including casual and shift work arrangements – the nature and specific hazards of the work – known occurrences of accidents or illnesses – the distance from the workplace to the nearest available and appropriate medical services.
First Aid boxDesign• Sturdy, portable, and clearly marked.Location• clearly identifiable, well-illuminated and accessible location.• The box should be kept locked and the key thereto kept by responsible person available during all working hours.• The employees should be informed of the location of all first aid boxes.
First Aid boxContents• First-aid boxes should contain a sufficient quantity of suitable first-aid materials.• They should not contain oral medication of any kind other than those required for first-aid treatment.• Check frequently to make sure they are fully equipped and all items are usable.• Recommended contents of a first-aid box are listed in DOSH guidelines.• First aid boxes should not contain items likely to be toxic or open to be misuse. Any first aid boxes containing prescription drugs must be securely locked and accessible only to properly trained personnel.
First Aid boxNumber of First Aid Boxes• At least one first aid box should be provided for every 100 employees or part thereof.• Extra first aid boxes should be provided for each additional 50 employees at the workplace.• In a large establishment, which covers a wide area, or occupies several floors in a building, more than one first aid kit will need to be provided.• For mobile workplaces, a first aid box should be located in each vehicle. (ACT Public Service)
First Aid boxAccessibility of First Aid Boxes• The first aid box must be readily accessible in case of emergency.• It should be located not more than 100 metres from the furthest workplace and not more than one story above or below the floor level of the workplace.• The first aid box should be portable or mounted in such a way as to allow it to be removed and carried to an injured person.• There must be immediate access to appropriate treatment in areas of specific hazards, such as: – hazardous substances and dangerous goods (corrosives, cyanide, hydrogen fluoride, pesticides) – machinery or equipment (eg plant maintenance, construction, warehousing, and logging). (Australian Capital Territory Public Services)
First Aid RoomDesign• The room should be large enough to hold a couch and still have space for people to move about.• Emergency lighting• Easily cleaned walls, floor, and ceiling• Non slip floor• Privacy• Comfortable temperature and humidity• Clearly identified as a first-aid room by means of a sign
First Aid RoomLocation• proximity to shower, lifts and main passageways• accessibility to work areas and car parkItems in First-Aid Room• Recommended items listed in DOSH guidelines
SPECIAL FIRST-AID REQUIREMENTSProvision for Mass Casualties:• In a workplace where there is a potential risk of mass casualties → provide a safe place for evacuation and for the availability of adequate equipment (e.g. stretchers, wheelchairs, sheets, bandages, blankets, etc).Special Instructions:• In any place of work where a chemical hazardous to health is used → the current Chemical Safety Data Sheet (CSDS) for that chemical must be available and easily accessible to the employees• Special training for first aider on early management in cases of chemical poisoning (i.e decontamination).
SPECIAL FIRST-AID REQUIREMENTSProtective Clothing and Equipment:• Protective clothing and equipment should be provided, properly stored and checked regularly• Principle of Universal Precautions• First-aiders are recommended to be immunized for Hepatitis B.Cleaning Up:• Wash hands or any other body surfaces splashed with blood or other body fluids as soon as possible with soap and water.• Contaminated surfaces should be cleansed and disinfected.
Worker awareness• Every workers should be aware of: – the nature of first aid facilities – the location of the first aid boxes and first aid rooms – the names and work locations (including telephone numbers) of First Aiders – the procedures to be followed when first aid is required – Standards precaution for the control of infection including blood-borne infections
Worker awarenessThe information should be kept up to date and provided:• When an employee first becomes employed• when there is significant change in the location of the first aid facilities or services• When there are changes in names, locations, or contact numbers of trained first aiders.