Reprinted from the ACJ - July, 1997
A couple of issues back we discussed what items should be in your first aid cabinet.
If it was a slow week and you set about reconfiguring your first aid kit so you would be ready in an emergency, good for you. Just a reminder: Check it periodically to make sure that the essentials haven't disappeared.
If it was a very slow week and your intellectual biorhythms were at a peak, you may have made the great leap forward and asked yourself, "I have a great first aid kit, wouldn't it be wonderful if I knew how to use this stuff?"
Proper first aid technique is essential because no matter how complete and well presented your first aid kit is, a guy laying on the floor bleeding will be unimpressed unless you take something out of the cabinet and help him. Injured folks are selfish that way.
Accepting that you need to learn first aid technique is the easy part. Getting the proper training is more of a gray area. There are no "standard" guidelines for proper training of workplace personnel in occupational first aid.
Basic first aid programs are numerous and varied. In 1994, a government task force documented 200 different sources and courses designed to teach first aid. The content varied, and some were better than others at answering the important questions: Quick, do you put butter on a burn? Is a tourniquet ever a good idea? Should you use the Looney Tunes or Barney & Friends Band-Aid on that cut?
The task force stopped short of recommending any specific courses, so OSHA stepped in and began qualifying sources as "Acceptable" because they taught what OSHA felt were the "necessary basics."
Faced with the difficulty of deciding which courses were best and attempting to follow course changes pushed OSHA to take the next step. Ten years ago the agency stopped qualifying training programs. Consistency of content was the real problem.
Some excellent training programs do exist. The Red Cross provides very good first aid courses, as do many private firms. But again, course content should be consistent across the board. Enter a consensus group of safety personnel, legislators, and industry types determined to "standardize" first aid training. They have developed an operational model based on the Department of Transportation's Emergency Medical Service (EMS)/Emergency Medical Technician (EMT) program.
The guidelines they recommend will allow you as the "shop EMT" to interface smoothly with any procedures the paramedics may need to implement, should the injury require that they be called in. The curriculum teaches skills that enhance what EMTs call the "chain of survival," starting with procedures that are immediately necessary in an emergency. As an example, the decision about tourniquet use comes before the designer Band-Aid selection.
Just because Jim says he is Okay
after head butting a hoist,
doesn't mean he is...
The core program is referred to as "One adult - one rescuer," and touches on these 12 topics. (They are not necessarily listed in order of importance.)
1. Responsibility in the workplace. Important so that we all don't stand around watching someone bleed while we draw straws to see who helps.
2. Scene safety and body fluid isolation. Remember our discussion of blood borne pathogens? Keep those gloves and plastic bags handy.
3. Regulatory/ethical issues. You had to know some form of political paperwork would be involved. But from an employer's point of view, if someone does something wrong, who is responsible?
4. Emergency moves and positioning. Moving the injured from a life threatening area is one example. Others might include: head between your knees; elevating the injured limb; right hand red, left foot blue, etc.
5. Airway management/ rescue breathing. Here we mesh with CPR's ABCs. A is for open airway, B is for breathing, C is for another paragraph.
6. Scene hazard assessment. Sending a rescuer into a life threatening situation may result in two casualties. Not sending him in may guarantee one Tough decision.
7. Patient assessment. Just because Jim says he is OK after head butting a hoist doesn't mean he is. Someone must be trained to observe his behavior and make sure he is OK.
8. Warning signs of impending emergency. Training should allow responders to recognize the signs that someone is spiraling down toward a full blown "Code Blue."
9. Managing responsiveness. To me, this is part of the above requirement, since a patient's responsiveness gives a good clue as to whether they are getting better or worse.
10. Bleeding control. Pressure points and tourniquets are obviously part of this, but so is recognizing internal bleeding.
11. Shock management. Trauma shock, not electric shock. Although electrical shock can result in trauma shock. Ah, the circle of life.
12. Stabilizing skeletal/spine injuries. "Do no harm" is a doctor's motto, and it should be ours. The less additional injury we cause while "helping," the better.
Listing these things on paper is easy, but learning them is difficult. I am not going to detail any specific training for two reasons. One, because I am out of room in this article. And two, because at this stage these guidelines are just suggestions. As a matter of fact, the consensus group is looking for opinions and suggestions from normal people like us. A site on the internet has the proposed plan available for comment.
So if you can navigate cyberspace, give them an e-mail at: http://www.dot.gov/ dotinfo/uscg.
Pull up "Services & Programs," then click on "Marine Safety," then "Publications & Reports," then "Studies of Interest from Non-CG Sources." Or just keep your eyes open for a published version of the guidelines in the near future.
However you do it, getting first aid training for yourself and your coworkers is important. Use these guidelines when choosing a first aid course. In our industry, I also suggest supplementing the training with "chemical exposure" and "burn first aid." Then we can gaze at our state-of-the-art first aid cabinet anticipating the call for "Rescue personnel, back shop-stat!"
The above article was written by David M. Brown, Chief Engineer of Johnson Manufacturing Company, Inc. and is published by JOHNSON with the expressed approval of the National Automotive Radiator Service Association and the Automotive Cooling Journal. Other reproduction or distribution of this information is forbidden without the written consent of JOHNSON and NARSA/ACJ. All rights reserved.
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114 Lost Grove Road / PO Box 96 / Princeton, Iowa 52768-0096
Phone 563-289-5123 or Fax 563-289-3825