First on the Scene
By Jean Lian
Injury prevention is important in every workplace, but being prepared also means being able to respond to an injury or medical emergency quickly and effectively. For a start, the need to provide some level of workplace first aid is mandated by provincial requirements, which are specific to each jurisdiction.
“They have to ensure they meet the legal provincial requirement,” according to Claudio Dente, president of Dentec Safety Specialists in Newmarket, Ontario. “You also have to have a competent, trained person that has a certain level of first-aid experience.”
The first-aid equipment and training required depends on the number of employees, the types of hazards present and travel distance to a hospital or access to professional medical assistance.
Working with a joint workplace health and safety group to determine what the specific first-aid needs are is a good start. “You can look at the statistics within that workplace and try to determine what are the most likely injuries that would occur. Then they can begin to build it from that point,” advises Don Marentette, national director of first-aid programs at Canadian Red Cross in Winnipeg.
Doing a hazard assessment to find out what first-aid supplies are not part of mandatory requirements is also important, Dente notes. In Ontario and in most provinces, the basic first-aid kit includes a bandage, gauze, tape and a pair of scissors. “But a foundry has other hazards that are not really addressed in the standards — for example, burns.”
Another example is a meatpacking plant, where workers wield sharp tools. “You want bandages that would be capable of handling large wounds or punctures,” Yaffe notes.
Terry Brown, Toronto-based president of SOS Emergency Response Technologies, agrees that companies should go beyond just meeting basic workplace first-aid standards. “If you look at many of the provincial regulations, those are a starting point, the absolute minimum companies should do.”
Up and coming
Having the right first-aid products in a quantity befitting the size of a business is important. According to Dente, users should always ensure that their suppliers of first-aid products carry the appropriate Health Canada licence to import and distribute medical devices. He cites his company as one such firm that is licenced to distribute Class II and III medical devices, as well as assemble and customize first-aid kits that meet provincial regulatory requirements.
Class II devices refer to surgically invasive devices such as arterial or urethral catheters, dentures, contact lenses, home pregnancy tests, autologous blood reinfusion bags and syringe needles, while Class III devices include surgically invasive devices that are absorbed or remain in the body for at least 30 days, like an implantable coronary stent, mammography X-ray systems or prostate-specific antigen tests.
“When you are dealing with somebody that has a medical-device licence like we do, we go through a very stringent requirement and audit that are conducted by Health Canada,” Dente explains. Health Canada officers come onto the site to check a company’s quality-control program, go through the standard operating procedures and review inventory and receipts of goods to ensure that the products are compliant with Health Canada’s Class I, II, III and IV designations.
“Often with first-aid supplies, you get what you pay for,” says Marentette, who advises buyers to research where they obtain their supplies.
One of the major changes in the marketplace that Brown observes is the emergence of defibrillators and their affordability. “It is one of those items people don’t legally need, but I think most people are aware that they should have, and that is something that many organizations are going towards.”
Dente notes that many new products are coming into the AED marketplace, with some offering voice-accentuated instructions and videos.
Yaffe recommends that companies register their defibrillators with ambulance or emergency services, so that they are aware that they have a defibrillator and can guide them through the use of the device when required.
Another first-aid item that is becoming very popular is a tourniquet. “In the past, it was only reserved for professional responders or [in] military or rural settings. Now we have good science to tell us that this is teachable and it should be used in a first-aid setting everywhere,” Marentette says.
Human to err
Having a well-stocked first-aid kit is one thing; maintaining it to make sure that it remains functional is another. Some common oversights include not maintaining first-aid kits regularly, not understanding how the products are used and not having someone in charge of first-aid kits.
“In many cases, the first-aid kit is up in the wall, and anybody who injures himself just goes over,” Yaffe illustrates.
And then there are people who overlook their own protection when tending to the injured. “[When] a person is bleeding, you have to protect yourself by wearing protective gloves,” Yaffe cautions.
For Marentette, ignorance is the greatest evil. “First-aid kits are good, but if people don’t know where they are, how to use the stuff, they are useless. It is important for staff to review first-aid kits regularly and that everyone gets a chance to do it,” he adds.
One of the major oversights when it comes to workplace first aid is training, which ranks high on the agenda of the Canadian Red Cross. “Practising is a huge piece of what we are going to start encouraging workplaces and people to do more often, set up some formalized schedule where they can practise,” Marentette reveals. “Our research is showing us that skill degradation is happening at a 30-day mark after a training.”
The spectrum of training for first aid is vast, and it varies from jurisdiction to jurisdiction as well as from industry to industry. Canadian Red Cross offers a range of workplace first-aid training programs anywhere from a three-hour cardiac-pulmonary resuscitation course to a three-week emergency-responder course.
“All first-aid courses have an expiry date,” Brown says. For example, most first-aid training in Ontario has a three-year cycle, while in some cases, it may be only a two-year cycle.
According to Marentette, one “exciting” development is that the Canadian Red Cross and CSA Group gathered a group of oh&s decision makers in Ottawa in October 2013 to formalize an injury-reduction collaborative. “It has always baffled us in Red Cross, because everyone bleeds the same colour, so why do we have to have different kinds of standards?”
One of the discussions that came out of that group was that Canada needs a standard level of competencies in workplace first aid. “So we engaged the CSA in 2014 to see if they had interest in that work. They took a high priority. We have been working for the last year and a half to develop a standard set of workplace first-aid competencies.”
Allison Hawkins, manager of corporate affairs with CSA Group in Toronto, says the scope of the new standard is to provide minimum requirements for a workplace first-aid training program, which includes program design considerations, learning objectives and competencies and quality management. “The standards are voluntary. CSA Group has no mandate to compel or enforce the adoption of standards,” she says. The public review period should begin this summer, and publication of the standards is targeted for mid-2017.
Talk the talk
A well-stocked and -maintained first-aid kit aside, providing effective first aid includes knowing how to convey information during an emergency.
Kit Care Corporation, which inspects and maintains professional first-aid kits, also offers consultations on communication for emergency assistance. Yaffe points out that in a lot of businesses, making an external call requires dialing the prefix nine before entering the phone number. “Some businesses have that during the week, but on weekends or evenings, they change it because of smaller staff [strength],” he notes. “That information has to be understood by first-aid attendants and people providing first aid.”
He also stresses the need to communicate clearly when making a 9-1-1 call. Health issues relating to the respiratory system or the heart rank tops on the priority list, so that gets immediate attention.
Identifying the location of a place accurately is also crucial. “If you have a street that is new, something that may not be on the maps, advise them as to how to get into that area,” Yaffe advises. The city of streets with common names like “Main Street”, or identical residential or industrial street names that are used in different parts of a city, also need to be stated.
Greeters should station themselves outside a facility to direct first responders to the scene upon their arrival. “If you have an individual who has been injured in the back of a facility,” Yaffe says, “you want to be able to direct the EMS to go into the back of the building rather than come to the front, because time is of the essence.”
According to the Canadian Centre for Occupational Health and Safety (CCOHS) in Hamilton, Ontario, first-aid regulations specify in detail each jurisdiction’s requirements. Legislation may also stipulate that first-aid supplies are to be stocked with required and appropriate items and checked regularly for expiry dates.
“Usually, the first-aid products that have expiry dates are ointments, creams, tablets and eyewash,” Yaffe says. A regular inspection of the kit helps to weed out and replace supplies that are broken, have changed in colour, show signs that their sterility packages have been compromised or lost their adhesiveness as in the case of bandages.
Employers are usually required to maintain written records of all injuries and treatment given. Depending on the jobsite, there may also be a need to consider chemicals that may require a specific sequence of treatment steps, crowd control, special needs for persons with disabilities or known medical conditions, employees who work alone and transportation to a medical facility, the CCOHS adds.
As with all things else, due diligence is key. Brown says there are many first-aid items and training that companies should be prepared to provide to give themselves a better chance of responding to emergencies.
Jean Lian is the editor of OHS Canada.