Dr. David Roston wrote this article and it was featured in the October issue of ISHN Magazine.
The ideal time to respond to a medical emergency is well before the emergency happens. The Boy Scout motto, “Be Prepared”, should guide a company’s thinking about emergency response in general, and specifically applies to emergency medical response. Establishing policies in advance, publishing those policies in the employee manual or posting them on the company intranet, training individuals in the appropriate protocols, and having necessary equipment in place, all ensure that the emergency response to medical emergencies is as effective as possible.
The aim of this article is to help companies understand what is required with regard to medical emergencies in the workplace, and specific actions to be taken when confronting a medical emergency. Since each company has its own unique risks, recommendations will need to be adapted to fit the specific work environment.
What constitutes a medical emergency? The answer is any acute illness or injury that poses a threat to the life or wellbeing of the individual. Below is a truncated list of warning signs from the American College of Emergency Physicians:
- Bleeding which cannot be controlled
- Change in mental status or alertness
- Chest pain
- Loss of consciousness or dizziness
- Head or spine injury
- Severe vomiting
- Sudden, severe pain
- Acute injury (motor vehicle accident, burns, near drowning, etc.)
- Ingestion of poison
- Suicidal or homicidal intention
OSHA requires companies to provide prompt first aid, which means having first aid supplies and trained first aid providers available if no treatment facilities are located nearby. There should be “medical personnel available for advice and consultation”, and “facilities for quick drenching or flushing of the eyes and body” in the event of exposure to “corrosive materials” (29 CFR 1910.151).
According to the OSHA Small Business Handbook, employees who are responsible for emergency medical response should be given training in first aid. OSHA encourages companies to train at least one employee in first aid and cardiopulmonary resuscitation (CPR). If companies provide an Automated External Defibrillator (AED) in the workplace, a sufficient number of their employees should be trained in its use.
OSHA requires that employers train any employees with potential exposure to blood or other potentially infectious material under the Bloodborne Pathogen Standard (29 CFR 1910.1030(g)(2)). An employee whose duties involve providing first aid and medical assistance falls under this standard. These emergency medical responders should also be knowledgeable about bloodborne pathogens and the use of PPE (personal protective equipment) to prevent exposures. They should be offered Hepatitis B vaccinations as well.
When asked to clarify the standard with regard to the meaning of “nearby” treatment facilities, OSHA stated that there should be emergency care available within 3-4 minutes of the workplace where the potential for life threatening accidents exists (for example, suffocation or electrocution). Offices and other workplaces with a lower risk of injury have up to 15 minutes to reach treatment facilities. Certain industries with remote work environments, such as electric power and logging, are required to provide first aid training to their employees.
Larger companies may have an on-site medical staff to deal with medical emergencies. Smaller companies should assign an individual to keep medical supplies up-to-date and restocked, and to act as the company contact in the event of a medical emergency. Phone numbers of the nearest emergency department and ambulance service should be readily available. Companies should have a plan in place which specifies who and when to call in the event of a medical emergency.
When faced with a life threatening medical emergency at work, the first action should be to call 911. It is better to err on the side of caution by calling 911, than to delay and put an individual’s life at risk. If the victim is unresponsive, the American Heart Association recommends that CPR be started as soon as possible. The injured person should not be moved unless the area presents a safety risk to the injured person and/or the first responders. An individual with a suspected neck injury should not be moved in order to avoid potential damage to the spinal cord
When an AED is available, it should be utilized as quickly as possible. Every minute counts when resuscitating an individual who has had a sudden cardiac arrest. Survival rates have been as high as 90% when an AED has been used in the first minute of sudden cardiac arrest. The rates decrease by 7-10% every minute after that. Setting up an AED program is beyond the scope of this article. Suffice it to say that purchasing an AED is only the first step in the process, and that a comprehensive program for AED maintenance (including battery replacement), employee training, and physician oversight is essential. The locations of the AED should be carefully chosen to maximize the efficiency of their use, and then widely advertised so that the employees know where to find them in an emergency. Ideally, AED’s should be placed in areas where employees congregate, such as cafeterias or break areas. There must be regular first aid and AED refresher training for employees to help maintain skills.
For non-cardiac injuries, basic first aid should be provided. First aid kits should be available. The ANSI Z308.1-2009 standard specifies what items the first aid kits should contain. OSHA recommends that first aid training should prepare providers to assess the injury scene to determine:
- General safety of scene
- Sequence of accident causing injury
- Estimate of how many individuals were injured
- Identification of people able to help
- Initial assessment of injured individuals with regard to airway, breathing, circulation and degree of bleeding
- Secondary assessment about injuries
OSHA requires that first aid training emphasizes the importance of following universal precautions in order to avoid exposure to potentially infectious bodily fluids. Gloves, personal protective equipment, and appropriate containers for disposal of sharp items must be easily accessible.
Benjamin Franklin said the following: “By failing to prepare, you are preparing to fail,” and “an ounce of prevention is worth a pound of cure.” Companies should take heed of these aphorisms and should do their best to prepare for potential medical emergencies.