Legislation in the UK on confined space and at heights working locations insists that employers ensure arrangements are in place to be able to facilitate an emergency rescue of an injured or incapacitated person immediately after an incident occurs.
During most working activities, this requirement is rarely realised due to prior planning and a stringent health and safety approach towards the task in hand. Unfortunately, there are recorded cases where immediate emergency response by other site operatives have been required prior to arrival of the statutory emergency services, as an individual has been taken ill or injured within the workplace.
Associated legislation is equal parts directive and vague when it comes to identifying the provisions that should be made to accommodate a rescue activity, often referring to ‘reasonably practicable’ measures. It is without doubt reasonable to plan for incidents that have been identified as likely within the risk assessment stage. Thereafter, safety and rescue equipment, along with safeguarding measures, should be put in place in line with the exposure to risks and hazards identified. Most workplaces make sufficient arrangements including purchasing or hiring in related safety/rescue equipment to accommodate some types of rescue within a technically challenging environment, such as a confined space or at height location. Indeed, most employers make arrangements to train a percentage of their workforce to the required level in order to achieve this task, but how much consideration is there to the potential medical related exposure that designated rescue operatives may have to respond to, during or after the rescue is achieved? Making the assumption that the statutory emergency services will respond to an incident in a timely manner is no longer an accepted argument within UK courts of law. They will of course attend any serious and/or life threatening incident; however, the response provided by them may not be prompt or with the appropriate medical skillset, so therefore cannot be solely relied upon, at least in the first instance.
Getting an individual to a place of safety following a workplace incident can be physically and mentally challenging. From a confined space or at height location, there is no doubt that it may well be a physically demanding activity to undertake. Generally though, the requirement to relocate an injured or incapacitated person to a place of safety is achievable. Once at that point of safety (if not before), the rescuers attention on how to manage the associated medical implications of his or her casualty has to be addressed, and possibly quickly. Some medical conditions are not easily identifiable and others may require swift attention. In the event of time critical medical conditions they are just that, time critical. They require a confident and committed response from medically trained and ideally experienced individuals.
Appropriate first response
In the UK, the Health and Safety Executive (HSE) makes First Aid training mandatory in the workplace. Most if not all employers would agree that a percentage of operatives should be trained in first aid, so that in the event of a medically related incident someone is present to administer immediate aid where required. For most workplaces, this level of training usually varies between the recognised one day Emergency First Aid (EFA) or three days First Aid at Work (FAW) courses. The EFA course is designed to teach lifesaving skills such as cardio pulmonary resuscitation (CPR) and tending open wounds, burns and choking. Because of restraints on its timescale, it cannot offer any level of training beyond that of basic life support instruction. The FAW course, however, offers a more comprehensive level of understanding. The syllabus extends beyond that listed in the EFA and includes instruction in conditions such as crush injuries, fractured bones, anaphylaxis, drowning, head injuries, medical conditions such as diabetes and more. Being able to follow guidelines to recognise danger, gauge for casualty response, check the airway, look for normal breathing and check for a pulse is great and should never be belittled; however, is first aid a sufficient level of training when working in technically challenging environments where the potential for harm and the subsequent potential injuries are more serious?
The UK has in recent years seen a change to how agencies such as the National Health Service (NHS) respond to an ever-growing demand on services. One element that continues to grow is the Community First Responder (CFR) scheme. Statistics have proven that in many cases, having someone with advanced basic life support skills attend to a patient as quickly as possible can and often does make a difference. These individuals are trained in advance first aid procedures and are capable of offering immediate assistance during potentially life threatening conditions. Many lives have been saved as a result of an immediate attendance from a trained individual who is better prepared to not only recognise medical conditions, but also respond to them. Readily available training courses at this level include First Person on Scene (FPOS) and First Response Emergency Care (FREC). As modular courses, training is built up to the required level over time and creates better prepared individuals who may be responsible for offering lifesaving services prior to statutory emergency service response. It is this level of training that is more in line with providing an appropriate response within technically challenging workplace locations.
First response and emergency care
During a site-based incident, personnel may encounter a casualty with serious medical or trauma conditions that require an immediate response. Being first on the scene, however, is not always enough. Having the confidence to take action and make potentially lifesaving decisions within an already stressful situation is not something that comes easily. Could anyone categorically say that having received training in any subject makes them competent? Knowledgeable, yes, but invariably it is experience and exposure that defines competency. This is never more evident than when the subject in hand is appropriately offering medical assistance to another person.
A recent survey by the British Heart Foundation has produced the statistic that within the East Midlands region of the UK, only one in three people would be able to identify and appropriately respond to a cardiac arrest casualty. This is an alarming figure and when considered in an on-site incident, where a casualty has sustained multiple injuries which may then induce cardiac arrest, responder identification and subsequent First Aid intervention are skills that may keep that individual alive.
Having personnel trained to a standard of at least first aid level ensures that some level of on-site lifesaving skills are present when needed. For conscientious employers, however, enhanced and bespoke first response training is readily available. Where a reliance on statutory emergency service assistance may be some time away, training to a higher level is a must. Training courses such as first person on scene (FPOS) or first response emergency care (FREC) have been created for individuals working either remotely or within a team and with a responsibility for providing a higher level of immediate emergency response. Achievable by most persons within a relatively short timeframe, this training includes key recognition and emergency response to a wide range of medical and trauma conditions. Additionally, the inclusion and training in supportive medical equipment such as automatic external defibrillators (AED) also further enhances their role as an on-site first responder.
Having delivered this level of teaching, I have often encountered site operatives that are initially resistant to undertaking rescue based medical training, as they feel an overwhelming burden of responsibility has suddenly been placed upon them. When you highlight, however, that most people would immediately offer some kind of assistance during an emergency and that this level of training will merely enhance that natural instinct, their resilience often subsides. Undertaking this level of training is achievable by most persons and within realistic timeframes, too. Having previously referred to the FPOS and FREC training, these accredited courses are available nationally and usually achieved within a five day period. These courses teach operatives to respond to an array of incidents including severe blood loss (a very likely industrial scenario), where use of haemostatic dressings can make a real difference. Indeed, considerations are not exclusive to workplace accidents, but what of operatives’ pre-existing medical conditions? These would equally require the same level of response if they were to occur within the workplace. Successful delegates of this training leave training centres better prepared with core competency advanced first aid skills to hand. When you consider that the decisions made and actions taken during and immediately after an on-site emergency may result in lives being saved or lost; undertaking this level of training becomes ever more apparent and relevant.
On-site emergency rescue and appropriate employer provisions are often the subject of many contentious debates. There is an obvious legal and ethical requirement to support operatives undertaking higher risk activities appropriately, but to what extend? The law says on-site facilities should be at hand to accommodate a rescue and/or medical intervention prior to response from the statutory emergency services. Additionally, UK statistics quote that 999 requests grow on average by an additional million calls each year. This increasing demand for service invariably means that, as and when it is required, a prompt and expedited response may not be guaranteed. During an on-site incident where a person is injured or taken ill, other operatives present may be the only response available for an undefined period of time. So having an operative with an enhanced skillset that could make the difference between a casualty living or dying is invaluable.
It is not enough to physically move a person from a point of harm to a place of safety without considering their medical wellbeing. With advanced first aid training courses available nationally it does beg the question: why would any conscientious employer allow their workforce to work within elevated risk environments with the potential of harm present, with nothing more than basic life support skills such as ‘danger, response, airway, breathing’ to hand? We should be addressing appropriate emergency response levels and considering potential medical requirements to the same level as rescue equipment levels. Once we have done that, then and only then can we genuinely say we have demonstrated due diligence along with appropriate consideration to our exposed workforce.
Published: 15th Dec 2015 in Health and Safety Middle East