First Aid at Work

The Role of a First Aider

First Aiders are employees who have been trained in accordance with standards set by the Health & Safety Executive (HSE).

Their role is to provide first aid assistance to colleagues if they suffer the effects of an injury or illness.

They must also ensure that first aid facilities within their own areas such as first aid boxes or grab bags are maintained appropriately.

Their aim is to:

  • Preserve life
  • Prevent the situation from worsening
  • Promote recovery

First Aiders are able to:

  • act safely, promptly and effectively when an emergency occurs
  • administer cardio-pulmonary resuscitation (CPR) promptly and effectively
  • administer first aid safely, promptly and effectively to a casualty who is unconscious
  • recognise common major illnesses and take appropriate action
  • maintain simple factual records

They are also able to administer first aid safely, promptly and effectively to a casualty who may be suffering from a range of injuries.

What is an appointed person?

When an employer’s first-aid needs assessment indicates that a first-aider is unnecessary, the minimum requirement is to appoint a person to take charge of first-aid arrangements. The roles of this appointed person include looking after the first-aid equipment and facilities and calling the emergency services when required. They can also provide emergency cover, within their role and competence, where a first-aider is absent due to unforeseen circumstances (annual leave does not count).

Do appointed persons need to undertake first-aid training?

To fulfil their role, appointed persons do not need first-aid training. However, emergency first-aid training courses are available.

PRIMARY SURVEY

Assess conditions

  • Remain calm.
  • Assess the scene and seriousness.
  • Determine what happened, how many people are involved and the exact location

If on the road

  • Make sure you stay safe: keep off the road. If you need to stop or warn approaching cars, signal to them from the pavement. Wear fluorescent reflective clothing use warning triangles, flashing lights and hazard warning lights. Don’t smoke
  • If you are in a car and you come across an accident, first park safely and turn off the engine before you get out to help. Use a hazard triangle if necessary.
  • Consider the safety of others. Immobilize the vehicle/s, look out for hazards – leaking fuel, chemicals, broken glass or shed loads – guide uninjured passengers to a place of safety

Assess casualties

  • How many casualties are there?
  • What is the severity of the injuries?
  • Is anyone trapped?
  • Is there a danger of fire?

Call for help

  • Dial 999 (or 112) for the emergency services. If there is no phone nearby, recruit help and send two people in opposite directions

Apply emergency first aid

  • Remain calm. Reassure the victims.
  • Do not allow smoking or offer food or drink to casualties as this could hamper urgent medical treatment

Calling 999 (112)

Do this as soon as you can or get someone else to do it while you deal with an injured person. You will need to tell the emergency services:

  • where you are
  • what has happened (describe the accident)
  • how many people are injured
  • whether they are breathing or bleeding.

The operator will talk you through what to do while you wait for an ambulance to arrive.

RECOVERY POSITION

recov

Use the recovery position for an unconscious person who is breathing. Roll their body towards you and onto their side. Then:

  • Tilt the head back to keep the airway clear.
  • Ensure that the head and neck are in a straight line.
  • Keep the hip and knee bent at 90º to keep body stable and comfortable.
  • Use the casualty’s hand to support the head, but it should remain lower than the body to allow fluids to drain from the mouth.

RESUSCITATION What is it?

This technique is for an adult casualty who is unresponsive and isn’t breathing normally.

If you’re on your own, call an ambulance before you start resuscitation.

Actions

Check for vital signs

  • Check for response – gently shake their shoulder and ask if they’re all right.
  • If there’s no response, shout for help and open their airway. Place one hand on their forehead and gently tilt the head back and lift the chin.
  • Check for breathing – look for chest movement, listen for sounds of breathing and feel for their breath on your cheek. Do this for ten seconds.

If the person is not breathing normally, you must call an ambulance and then start CPR which is a combination of chest compressions and rescue breaths.

Giving chest compressions

  • Place your hands on centre of their chest and with the heel of your hand press down 30 times.
  • Press down 5-6 cms.
  • Do this at a rate of 100 – 120 times a minute.

If you have not been trained in CPR or are unwilling or unable to give rescue breaths give chest compressions only.

Giving rescue breaths

  • Open the airway, gently tilt the head back and lift the chin.
  • Pinch the person’s nose; place your mouth over their mouth and – by blowing steadily – attempt 2 rescue breaths each lasting one second.

Continue this sequence of 30 chest compressions and 2 rescue breaths until emergency help arrives or the casualty starts to show signs of regaining consciousness; such as coughing, opening their eyes, moving purposefully and starting to breathe normally.

If you are unable or unwilling to give rescue breaths give chest compressions alone.

REFERENCE HSE LEAFLET

BLEEDING

Put pressure on the wound

  1. Put pressure on the wound with whatever is available to stop or slow down the flow of blood.
  2. As soon as possible, call 999 or get someone else to do it.
  3. Keep pressure on the wound until help arrives.

Medical Shock

Shock is a life-threatening medical condition as a result of insufficient blood flow throughout the body. Shock often accompanies severe injury or illness. Medical shock is a medical emergency and can lead to other conditions such as lack of oxygen in the body’s tissues (hypoxia), heart attack (cardiac arrest) or organ damage. It requires immediate treatment as symptoms can worsen rapidly.

Medical shock is different than emotional, or psychological, shock that can occur following a traumatic or frightening emotional event.

What are the types of shock?

Septic shock results from bacteria multiplying in the blood and releasing toxins. Common causes of this are pneumonia, intra-abdominal infections (such as a ruptured appendix) and meningitis.

Anaphylactic shock is a type of severe hypersensitivity or allergic reaction. Causes include allergy to insect stings, medicines or foods (nuts, berries, seafood), etc.

Cardiogenic shock happens when the heart is damaged and unable to supply sufficient blood to the body. This can be the end result of a heart attack or congestive heart failure.

Hypovolemic shock is caused by severe blood and fluid loss, such as from traumatic bodily injury, which makes the heart unable to pump enough blood to the body.

Neurogenic shock is caused by spinal cord injury, usually as a result of a traumatic accident or injury.

What is the treatment for shock?

Depending on the type or the cause of the shock, treatments differ. In general, fluid resuscitation (giving a large amount of fluid to raise blood pressure quickly) with an IV in the ambulance or emergency room is the first-line treatment for all types of shock. The doctor will also administer medications such as epinephrine, norepinephrine or dopamine to the fluids to try to raise a patient’s blood pressure to ensure blood flow to the vital organs.

Tests (for example, X-rays, blood tests, EKGs) will determine the underlying cause of the shock and uncover the severity of the patient’s illness.

  • Call 911 for immediate medical attention any time a person has symptoms of shock. Do not wait for symptoms to worsen before calling for help. Stay with the person until help arrives.
  • While waiting for help or on the way to the emergency room, check the person’s airway, breathing and circulation (the ABCs). Administer CPR if you are trained. If the person is breathing on his or her own, continue to check breathing every 2 minutes until help arrives.
  • Do NOT move a person who has a known or suspected spinal injury.
  • Have the person lie down on his or her back with the feet elevated above the head (if raising the legs causes pain or injury, keep the person flat) to increase blood flow to vital organs. Do not raise the head.
  • Keep the person warm and comfortable. Loosen tight clothing and cover them with a blanket.
  • Do not give fluids by mouth, even if the person complains of thirst. There is a choking risk in the event of sudden loss of consciousness.
  • Give appropriate first aid for any injuries.
  • Direct pressure should be applied to any wounds that are bleeding significantly.

Pregnant women

Always put an unconscious pregnant woman in recovery position on her left side . This prevents compression of the Inferior vena cava by the uterus, which could be fatal for both the mother and the child.

What to do after a fall

Try not to panic if you have a fall. It is likely that you will feel shocked and a bit shaken, but staying calm will help you to gather your thoughts and remember what to do.

When you are calm, ask yourself whether you feel able to get up. If you are not hurt and you feel strong enough to get up, follow the steps listed below.

  • Do not get up quickly. Roll onto your hands and knees and look for a stable piece of furniture, such as a chair or bed.
  • Crawl over to the piece of furniture and, if possible, put something soft under your knees.
  • Hold on to the furniture with both hands to support yourself.
  • Place one foot flat on the floor, with your knee bent in front of your body.
  • When you feel ready, slowly get up.
  • Sit down and rest for a while before carrying on with your daily activities.

If you are hurt or unable to get up, follow the steps listed below.

  • Try to get someone’s attention by calling out for help, banging on the wall or floor (if there is someone on the floor below you) or using your aid call button (if you have one). If possible, crawl to a telephone and dial 999 to request an ambulance.
  • While you are waiting for help to arrive, try to get as comfortable and as warm as you can by moving to a carpeted area. Try to reach something warm to put over you (particularly your legs and feet), such as a blanket or a dressing gown.
  • Try to move regularly to avoid getting pressure sores and to help you keep comfortable. Change your position regularly (at least once every half an hour).

Treating heat exhaustion and heatstroke

Heat exhaustion
If you suspect that someone has heat exhaustion, follow the advice outlined below.

  • Get them to rest in a cool place – ideally a room with air conditioning or, if this isn’t possible, somewhere in the shade.
  • Get them to drink fluids – this should be water or a rehydration drink, such as a sports drink; they should stop taking fluid on board once their symptoms have greatly decreased (usually within two to three hours).
  • Avoid alcohol or caffeine as these can increase levels of dehydration.
  • Cool their skin with cold water – if available, use a cool shower or bath to cool them down, otherwise apply a cool, wet flannel or facecloth to their skin.
  • Loosen clothing and ensure that the person gets plenty of ventilation.

Dial 999 to request an ambulance if the person doesn’t respond to the above treatment within 30 minutes.

If the person is more at risk of developing heatstroke or suffering complications from dehydration then they should be taken to hospital either way. This group includes:

  • children under two years old
  • very elderly people
  • people with kidney, heart or circulation problems
  • people with diabetes who use insulin

Heatstroke

First aid

Always call an ambulance in cases of suspected heatstroke. While you’re waiting for the ambulance to arrive you should do the following:

  • Move the person to a cool area as quickly as possible.
  • Increase ventilation by opening windows or using a fan.
  • If they’re conscious, give them water to drink but don’t give them medication, such as aspirin or paracetamol.
  • Shower their skin with cool, but not cold, water (15-18°C).
  • Alternatively, cover their body with cool, damp towels or sheets, or immerse them in cool but not cold water.
  • It’s better to wait for medical supervision before fully immersing them in water, such as in a bath, as the body’s response could cause them harm.
  • Gently massage their skin to encourage circulation.
  • If they start to have a seizure (fit), move nearby objects out of the way to prevent injury (don’t use force or put anything in their mouth).
  • If the person is unconscious and vomiting, move them into the recovery position by turning them on their side and making sure that their airways are clear.

Hospital treatment

After a person has been admitted to hospital, the most important treatment goal is to lower their temperature as quickly as possible. This can be done in two ways:

  • immersing their body in an ice-bath
  • spraying their body with a mist of cool water while warm air is fanned over the body; the combination of cool water and warm air encourages rapid heat loss through evaporation

LIGHTING AT WORK

Regulation 8 of the Workplace (Health, Safety and Welfare) Regulations 1992 requires that every workplace has suitable and sufficient lighting. This should be by natural lighting, so far as is reasonably practicable. Good lighting, whether natural or artificial, has an important role to play in promoting health and safety at work. It helps us to see hazards and it can reduce the likelihood of visual fatigue and discomfort.

GUIDANCE

General guidance is available within the Approved Code of Practice on the Workplace Regulations, whilst more detailed considerations can be found in HS(G)38 Lighting at Work. Both have been used in the production of this element.

GENERAL

Lighting should be sufficient to allow people to work, use facilities and move from place to place safely and without experiencing eyestrain. Stairs should be well lit so that shadows are avoided. Where necessary, local lighting should be provided at individual workstations and at places of particular risk. Dazzling lights and annoying glare should be avoided. Lights should not be allowed to become obscured (e.g. by stacked goods)

Lighting should be subject to proper and efficient maintenance. Windows and skylights should where possible be cleaned regularly and allowed to admit maximum daylight whenever appropriate. Where workers are specially exposed to risk if normal lighting fails, emergency lighting must be provided.

What should employers do for employees who travel regularly or work elsewhere?

Employers are responsible for meeting the first-aid needs of their employees working away from the main site. The assessment of first-aid needs should determine whether:

  • those who travel long distances or are continuously mobile should carry a personal first-aid box; and
  • employees should be issued with personal communicators/mobile phones.
  • EMPLOYER AND EMPLOYEE DUTIES (source cipd).

The legal position

The concept that employees should be safe at work is not a recent phenomenon. Legislation was developed in the 1970s to streamline the many different statutes governing safety issues making management responsible for the provision and maintenance of adequate standards and policies. But although there are many different statutes governing safety issues, health and safety is not only governed by legislation. Under what is known as ‘common law’ all employers have a duty of care imposed on them to protect their employees. There is also a term implied into all employment contracts requiring employers to take care of their employees’ health and safety. For example, employers must:

  • provide a safe place of work
  • provide a safe system of work
  • provide adequate plant and equipment
  • recruit competent and safety conscious staff.

If an employer fails to take reasonable care in any of these areas, an employee may have a number of claims, including the ability to resign and claim constructive unfair dismissal.

Employees, too, have responsibilities and should work with their employer to develop a safe place of work.

Summary of employers’ health and safety obligations
Employers’ duties to provide a safe and healthy working environment arise from the core principles of negligence, contract, and the numerous specific statutory duties referred to above.

Employers should, at least:

  • publish a health and safety policy
  • arrange for the appointment of health and safety representatives
  • establish a health and safety committee if requested by a recognised trade union
  • appoint a competent person to evaluate risks and hazards
  • arrange periodic risk assessments
  • consult with employee health and safety representatives
  • prevent risks
  • inform staff of risks
  • combat risks at source
  • arrange protection from unavoidable risks
  • provide safety training
  • monitor and improve safety arrangements
  • provide health-risk surveillance
  • adapt work to the individual especially with respect to the design of workplaces
  • alleviate monotonous work
  • develop a prevention policy
  • appoint one or more competent persons to assist in undertaking preventative and protective measures
  • establish procedures to be followed in the event of serious and imminent danger to persons working in the organisation
  • require persons at work who are exposed to serious and imminent danger to be informed of the nature of the hazards and steps taken to protect them
  • provide comprehensible and relevant health and safety information
  • provide adequate health and safety training during working hours.

Producing a policy

All employers with more than five employees must have a statement of their health and safety policy. This statement must:

  • be written
  • be carefully thought through and demonstrate a commitment to managing health and safety
  • be workable
  • contains a general statement of intent to provide a safe and healthy working environment
  • be easily accessible and brought to the attention of all employees
  • give details of the health and safety responsibilities within the organisation
  • name key individuals
  • cover the systems and procedures in place
  • refer to other documents where appropriate
  • cover managing risk assessments
  • include arrangements for employee consultation, maintaining equipment, safe handling of substances
  • explain arrangements for training, supervision, accidents, first aid and emergencies
  • address stress, and drink and drug misuse.

Policies should be produced after consultation with employees and after conducting surveys on staff attitudes to health and safety. They should be also applied uniformly and there should be a system for regularly monitoring and reviewing the policy to ensure that it complies with current legislation.

A model safety policy with blanks to fill in is available from the Health and Safety Executive (HSE) although the adoption of a tailor-made policy is best practice and entirely ‘off the shelf’ policies are discouraged.

In cases of flagrant disregard, enforcement officers may issue improvement notices which if contravened lead to the ultimate potential sanctions of criminal penalties, including large fines and imprisonment.

Employers’ duties at a place of work
Some key examples of the employer’s duties with respect to a place of work include:

  • Under section 2 of HSWA, employers have an obligation to provide and maintain systems of work and a working environment which are, as far as is reasonably practicable, safe and without risk to health. The duty extends to providing maintenance of safe plant and systems of work, information, training, supervision and adequate support.
  • Under the Occupiers Liability Act 1957 a duties arise to provide employees and other visitors with a safe place of work.
  • All employers must take out and maintain an insurance policy known as an Employer’s Liability Insurance Certificate to cover against any diseases or injuries to employees sustained in the workplace. The Certificate must be displayed where it is visible to employees. Employers who fail to display the Certificate or fail to insure against liability may be fined.
  • Fire is a hazard in all workplaces. By law, all organisations must take precautionary measures by controlling fire risks and providing fire escape routes. They must also have a fire certificate from the fire authority, which should be kept on site. Employers must inform workers of fire risks and provide training in fire safety procedures and escape drills.
  • The Workplace (Health, Safety and Welfare) Regulations 1992 lay down minimum standards for workplaces and work in or near buildings. Employer’s duties include:
    • maintaining the workplace, equipment, devices and systems
    • providing ventilation by sufficient quantity of fresh and purified air
    • maintaining a reasonable temperature, and provision of thermometers
    • ensuring suitable, sufficient and natural light so far as is reasonably practicable
    • providing a clean workplace where waste materials must not be permitted to accumulate
    • providing sufficient floor area, height and unoccupied space
    • providing suitable and sufficient sanitary conveniences at readily accessible places.

Inspectors from the local authority Environmental Health Department, or HSE are responsible for enforcing health and safety law, and organisations can be prosecuted for breaches. All workplaces must be registered with either of these two bodies. Employees can report any breaches of the legislation or seek advice from them.

Risk assessment

A risk assessment is a vigilant examination of what, in a place of work, could cause harm to people so that the employer can assess if they have taken sufficient precautions to prevent damage and injury. Every employer must make a regular assessment of their premises to assess a number of risks. Self-employed workers have a duty to assess risks to themselves and others.

There are many detailed regulations that require risks in different industries to be assessed and HSE provides a variety of useful guidance. For example, guidance aimed at the commercial service and light industrial sectors identifies five steps2 which require employers to:

  • look for the hazards
  • decide who might be harmed and how
  • evaluate the risks and decide whether the existing precautions are adequate or whether more should be done
  • record their findings
  • review their assessment and revise it if necessary.

Risk assessments must include, for example:

  • measures needed to comply with the health and safety fire precautions
  • assessment of the risks to young people, taking immaturity and other factors into account
  • assessment of risks to new and expectant mothers – failure to carry out such assessments can amount to sex discrimination.

Areas where risk assessments can be carried out are:

  • workstations for users of personal computers
  • assessment of noise levels
  • safety audits to identify potential hazards conducted by accredited auditors
  • handling and lifting heavy loads.

Following a risk assessment, employers must make arrangements to implement any necessary measures and arrange for the provision of appropriate information and training.

Accidents and disease at work

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985 (known as RIDDOR) require employers to report any of the following to the HSE or the local council at once:

  • fatal accidents
  • major injury or conditions which require medical treatment
  • dangerous occurrences.

Other matters should be reported immediately, by telephone preferably, followed by a written report within seven days. These are:

  • accidents that prevent a worker from doing their normal work for more than three days
  • certain work-related diseases (poisoning, lung diseases, infections and other conditions must be reported when linked to specified types of work)
  • certain gas incidents.

Employers are legally obliged to provide first-aiders and inform all employees of the arrangements for getting first aid. Treatment of injured workers must be addressed without delay by an appointed first-aider.

An employer must record all workplace injuries, diseases, dangerous occurrences, or near accidents in an accident book. Employees must also report any accidents or illnesses caused by work and record the details in the accident book.

Absence management, stress and well-being

Absence management, both of short-term and long-term sickness, continues to be an issue. In particular, stress in the workplace has become a major cause of concern in recent years and has been the subject of several high-profile court cases and settlements. It is also quoted as one of the main reasons for absence. The employer’s duty of care and an increasing emphasis of EU legislation to make employers look after the physical as well as the psychological health of employees is bringing a move towards the concept of ‘wellness’ being promoted in some organisations. This aim aims to promote a preventative approach to dealing with illness issues.

 About programme designer and deliverer Clive Bonny CMC

Clive has been helping organisations develop and sustain social responsibility programmes since 1990, balance risk with reputation and maximise business continuity with practical onsite support. As an interim manager and professionally certified management consultant he has supported many organisations in the public sector, education, voluntary and private sector organisations improving product and service quality, contract project management and marketing communications. Assignments have covered the Middle East, Africa, USA, Asia and across EU with high growth organisations. He has founded a not-for-profit business education association. His clients include professional bodies and best practice award winners, developing diverse social enterprises with corporate responsibility standards. He is a signatory to the national Skills Pledge and Mindful Employer charter and a member of the Fraud Advisory Panel. Clive has current security clearance to Enhanced and Baseline Personnel Security Standard and undertakes background security approvals to enable businesses to win public sector contracts. Clive is an assessor for the best practice Responsible Business Standard.

Clive’s interim management roles include: IDeA approved consultant and trainer for public funded bodies; Launching a renewable energy design for off-grid buildings; introducing global ethics programmes for large organisations; Assessor for the Institute Certified Management Consultancy Award. He has delivered corporate social responsibility (CSR) programmes for professional bodies including the Institutes of Business Consultancy, The British Computer Society, Personnel and Development (on risk management).  Clive has held senior management positions for customer service operations, marketing, sales and human resource development. Recent active interim management clients include social enterprise innovators specialising in risk assessments, personnel security screening and wellbeing at work. He is developing a renewable energy solution for off-grid buildings. His advice on best practice has been published:

  • In Business: The Essential Fact File, endorsed by the late Sir John Harvey-Jones
  • The International Guide to Management Consultancy
  • The European Business Handbook
  • The Ivanhoe Career Guide
  • How To Be Your Own Management Consultant
  • The Corporate Communications Handbook
  • The Salespersons Pocketbook (also published in Russian, Arabic and Chinese)
  • The Business Writing Pocketbook (published internationally)
  • Business Ethics: Facing Up to the Issues (also in Russian)

Clive has co-authored and co-edited  research and advice on global ethics and corporate social responsibility standards and trends, published by The Economist. This was named as Book of the Month by the Sunday Times Enterprise Network and endorsed by the Chairman of Inchcape, Director General of the Institute of Directors, and Chairman of Investors in People. Clive is an active member of the relevant professional standards bodies and Best Practice Forums whose members he has trained, including Trade Associations; Chartered Management Institute; Chartered Institute of Personnel and Development; Royal Society of Arts Manufactures and Commerce; London Excellence; British Computer Society; and Mindful Employer. He spent a year as a VSO worker in a Zimbabwe Mission school, has advised EU embassy staff on cross-culture communications, and advises employers on diversity, talent management, employee benefits schemes and wellbeing at work.

Posted in Health and Wellbeing