Friday, November 30, 2012

First Aid Program Fundamental Part 5: Automated External Defibrillators

With recent advances in technology, automated external defibrillators (AEDs) are now widely available, safe, effective, portable, and easy to use. They provide the critical and necessary treatment for sudden cardiac arrest (SCA) caused by ventricular fibrillation, the uncoordinated beating of the heart leading to collapse and death. Using AEDs as soon as possible after sudden cardiac arrest, within 3-4 minutes, can lead to a 60% survival rate.3 CPR is of value because it supports the circulation and ventilation of the victim until an electric shock delivered by an AED can restore the fibrillating heart to normal.
All worksites are potential candidates for AED programs because of the possibility of SCA and the need for timely defibrillation. Each workplace should assess its own requirements for an AED program as part of its first-aid response.
A number of issues should be considered in setting up a worksite AED program: physician oversight; compliance with local, state and federal regulations; coordination with local EMS; a quality assurance program; and a periodic review, among others. The OSHA website at www.osha.gov or the websites of the
American College of Occupational and Environmental Medicine at www.acoem.org, the American Heart Association at www.americanheart. org, the American Red Cross at www.redcross.org, Federal Occupational Health at www.foh.dhhs.gov, and the National Center for Early Defibrillation at www.early-defib.org can provide additional information about AED program development.

Tuesday, November 20, 2012

First Aid Program Fundamentals Part 4: First-Aid Supplies

It is advisable for the employer to give a specific person the responsibility for choosing the types and amounts of first-aid supplies and for maintaining these supplies. The supplies must be adequate, should reflect the kinds of injuries that occur, and must be stored in an area where they are readily available for emergency access. An automated external defibrillator (AED) should be considered when selecting first-aid supplies and equipment.
A specific example of the minimal contents of a workplace firstaid kit is described in American National Standards Institute ANSI Z308.1 - 2003, Minimum Requirements for Workplace First Aid Kits. The kits described are suitable for small businesses. For large operations, employers should determine how many first-aid kits are needed, and if it is appropriate to augment the kits with additional first-aid equipment and supplies.
Employers who have unique or changing first-aid needs should consider upgrading their first-aid kits. The employer can use the OSHA 300 log, OSHA 301 reports or other records to identify the first-aid supply needs of their worksite. Consultation with the local fire and rescue service or emergency medical professionals may be beneficial. By assessing the specific needs of their workplaces, employers can ensure the availability of adequate first-aid supplies. Employers should periodically reassess the demand for these supplies and adjust their inventories.

Friday, November 9, 2012

First Aid Program Fundamentals Part 3: OSHA Requirements

Sudden injuries or illnesses, some of which may be life-threatening, occur at work. The OSHA First Aid standard (29 CFR 1910.151) requires trained first-aid providers at all workplaces of any size if there is no "infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees."

In addition to first-aid requirements of 29 CFR 1910.151, several OSHA standards also require training in cardiopulmonary resuscitation (CPR) because sudden cardiac arrest from asphyxiation, electrocution, or exertion may occur. CPR may keep the victim alive until EMS arrives to provide the next level of medical care. However, survival from this kind of care is low, only 5-7%, according to the American Heart Association. The OSHA standards requiring CPR training are:
1910.146 Permit-required Confined Spaces
1910.266 Appendix B: Logging Operations – First-Aid and CPR Training
1910.269 Electric Power Generation, Transmission, and Distribution
1910.410 Qualifications of Dive Team
1926.950 Construction Subpart V, Power Transmission and Distribution

If an employee is expected to render first aid as part of his or her job duties, the employee is covered by the requirements of the Occupational Exposure to Bloodborne Pathogens standard (29 CFR 1910.1030). This standard includes specific training requirements.

A few of the medical emergency procedures mentioned in this guide as first aid may be considered medical treatment for OSHA recordkeeping purposes. The OSHA Recording and Reporting Occupational Injuries and Illnesses regulation (29 CFR 1904) provides specific definitions of first aid and medical treatment. If a medical emergency procedure which is considered by 29 CFR 1904 to be medical treatment is performed on an employee with an
occupational injury or illness, then the injury or illness will be regarded as recordable on the OSHA 300 Log.

Tuesday, November 6, 2012

First Aid Program Fundamentals Part 2: The Risks

Risks: Injuries, Illnesses and Fatalities

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, according to National Safety Council estimates. The average cost per occupational fatality in 2004 exceeded one million dollars. To cover the costs to employers from workplace injuries, it has been calculated that each and every employee in this country would have had to generate $1,010 in revenue in 2004.2

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. The actual number of SCAs that happen at work are unknown. If an employee collapses without warning and is not attended to promptly and  effectively, the employee may die. Sudden cardiac arrest is caused by abnormal, uncoordinated beating of the heart or loss of the heartbeat altogether, usually as a result of a heart attack. Workplace events such as electrocution or exposure to low oxygen environments can lead to SCA. 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.

Assess the Risks and Design a First-Aid Program Specific for Worksite

 Obtaining and evaluating information about the injuries, illnesses and fatalities at a worksite are essential first steps in planning a first-aid program. Employers can use the OSHA 300 log, OSHA 301 forms, their Workers’ Compensation insurance carrier reports or other records to help identify the first-aid needs for their businesses. For risk assessment purposes, national data for injuries, illnesses and fatalities may be obtained from the Bureau of Labor Statistics (BLS) website at www.bls.gov/iif. The annual data, beginning in 2003, are grouped by the North American Industrial Classification System (NAICS) that assigns a numeric
code for each type of work establishment. Prior to 2003, the Standard Industrial Classification (SIC) system was used to categorize the data instead of NAICS.

 Employers should make an effort to obtain estimates of EMS response times for all permanent and temporary locations and for all times of the day and night at which they have workers on duty, and they should use that information when planning their first-aid program. When developing a workplace first-aid program, consultation with the local fire and rescue service or emergency medical professionals may be helpful for response time information and other program issues. Because it can be a workplace event, SCA should be considered by employers when planning a first-aid program.

It is advisable to put the First-Aid Program policies and procedures in writing. Policies and procedures should be communicated to all employees, including those workers who may not read or speak English. Language barriers should be addressed both in instructing employees on first-aid policies and procedures
and when designating individuals who will receive first-aid training and become the on-site first-aid providers.