First Aid and Burns

The correct and established treatment for burns is

“.. to hold the burn under cool running water for at least 20 minutes”.

This reduces the continuing damage generated by burning tissue.  

This has been the advice for decades and was recently reemphasised by the Victorian Government.  So why are burn creams still on the market?  

Perhaps there is a place  for burn creams – when 20 minutes’ supply of cool running water is not available.

In December 2008, the Australian Defence Forces used burn cream.  According to a media release

The ADF has been advised that four Iraqi civilian vehicles were damaged and two Iraqi men received superficial burns to their hands when they reportedly attempted to remove hot debris from their cars.

The Iraqi men were treated at the scene by Coalition Forces with burn cream.

Child Safety Australia recommends burn cream in a domestic first aid kit for the treatment of blisters.

The Australian Red Cross are emphatic, but allow room to move:

“NEVER use burn cream as an initial treatment.  This should only be used a doctor’s recommendation.”

In 2003 (reference not publicly available), the Mayo Clinic in Rochester advised the following first aid treatments for burns

  • With chemical burns, make sure the chemical and any clothing or jewelry in contact with the chemical are removed.
  • Cool the burn under running water long enough to reduce the pain, usually 15 to 20 minutes. If this isn’t possible, immerse the burn in cold water or cover with cold compresses. Don’t put ice directly on the burn. Ice can cause frostbite and further damage.
  • Once the burn is cooled, apply a lotion or moisturizer to soothe the area and prevent dryness. Don’t apply butter. It holds heat in the tissues and may cause more damage.
  • Cover the burn with a sterile gauze bandage. Wrap loosely. Bandaging keeps air off the burn and reduces the pain.
  • Take an over-the-counter pain medication unless your doctor has told you to avoid these medications.
  • Don’t break blisters. If the blister is broken, wash with antibacterial soap and water, apply an antibiotic ointment and bandage.

No mention of burn cream and only an antibiotic cream in relation to blisters.

Safety professionals seek evidence, from which solid and valid decisions can be made.  Why then does the initial treatment of burns have such a variety of advice? Can we simply put it down to the commercial desires of cream manufacturers? Or the  lack of  explanation from the defence forces?

I am old enough to have experienced my mother applying butter to my burns.  We have had generational change in this treatment but how much more change would have occurred if workplace first aiders, and parents, had not had burn creams advocated as a legitimate first aid treatment?

Kevin Jones

Draft guidance on musculoskeletal injuries in mining

Any inquiry into musculoskeletal disorders (MSD) in any industry is of great interest to OHS professionals as MSD are the bane of the profession.

The New South Wales Dept of Primary Industries (DPI) is requesting public comment on a new MSD guidance for the mining and extractive industries.  Below is some text from the media release

Industry comment is being sought by the Musculoskeletal Disorders (MSD) Working Party on the guidance document The Management of Musculoskeletal Disorders in the Mining and Extractives Industry.

The benefits of the guide are that it;
• Facilitates sites taking planned preventative measures;
• Uses the capacities that already exist and;
• Provides effective tools for sites to use.

Comments are welcome on the guidance through the DPI website by close of business 27 March 2009.

Kevin Jones

pages-from-management-of-msd-in-mining-guidance-circulation-for-comment-document

National OHS Review – initial comments

Several OHS colleagues on an international discussion forum have expressed some opinions on the final report of the Australia’s National Model OHS Law review.

Safety Alerts

One asked that better and more frequent safety alerts be published by the regulators and that those reports be based on fatalities, injuries and near misses.  

There is an inconsistency of  incident reporting in Australia.  For instance, emergency service departments have different ways of notifying the media of incidents.  Most rely on regular (multiple times each day) visits to their websites.  This option doesn’t work unless one has tracking software or are doing nothing else.  Several distribute email bulletins on a daily basis.  Most of the bulletins deal with traffic incidents, floods or bushfires, but several also report on emergency incidents to individuals and, although not explicit, many occur in workplaces.

Incident alerts from emergency services are good because it is a service that OHS regulators and enforcers also receive and act upon.

For many years, various Australia safety organisations have published OHS solutions databases or, initially, folders.  The maintenance of these have fluctuated over the years in relation to technological change and political interest.  It is pointless trying to establish a fixed-point or hard-copy library when the Internet is now the primary resource tool.

It should be added that considerable information can be garnered from court reports of OHS prosecutions however, the Magistrates’ Courts do not provide publicly accessible court reports so any matters heard at that level are rarely reported, except by someone who is sitting in the court.  To gain a proper understanding of the OHS legislative process, coverage of all levels of legal action should be encouraged.

Risk Management

Another colleague expressed concern about the use of “risk” throughout the report.  Below is a section of the report that explains the review panel’s approach:

“In Chapter 30, we discuss the role of the risk management  process in the model Act.  As we noted in our first report, risk  management is essential to achieving a safe and healthy work  environment. We found that risk management is implicit in the  definition of reasonably practicable, and as such, need not be  expressly required to be applied as part of the qualifier of
 the duties of care.  Further, as we discuss in this report, risks  can be successfully managed without mandating hazard  identification and risk assessment in all cases, particularly  where the hazards are well known and have universally  accepted controls.

 Therefore we recommend that the model Act should not  include a specific process of hazard identification and risk  assessment, or mandate a hierarchy of controls, but that the  regulation-making power in the model Act should allow for the  process to be established via regulation, with further guidance  provided in a code of practice, as is contemporary practice.
 The application of risk management process should however be  encouraged…” (page xviii)

Throughout the review process the Victorian OHS Act was the most influential piece of legislation and that Act removed the previous requirement to assess workplace risks to determine the most appropriate control measure.  WorkSafe Victoria had, for years, advocated in its publications and guidelines to “Find-Assess-Fix”.  The “Assess” was dropped in many instances as the suitable control measure had been well-established just not widely applied.  

The WorkSafe position was in response to those business operators who may say “I don’t care how hazardous the bloody thing is just fix it!”  It was hoped that this would save time and “unnecessary” paperwork, and that other State jurisdictions would take the same approach.  None did, and the removal of “Assess” confused businesses and safety professionals as it is a major inconsistency with the Australian Standard on Risk Management.

WorkSafe tried to calm the confusion by saying that they still though assessing risks was a good idea for many new and developing hazards, just that assessment could be done away with as a legislative requirements in most instances.

It seems like the National Review Panel supports the Victorian approach to risk assessment.  Not so long ago, the New South Wales government subsidised a lot of training for farmers and others in the agricultural sector on risk assessment.  Now it will have to re-explain.

The other concern with the panel’s approach to risk assessment is that it sees risk management as fitting within “reasonably practicable”, a concept that SafetyAtWorkBlog is not convinced helps in managing safety.  “Reasonably practicable” is a concept that is defined and refined through prosecutions and court processes, therefore, it can change and it is best interpreted by lawyers.  OHS legislation was designed to be readily understood by the layman for where the responsibility for safety sits with the employer and, to a lesser extent, the employee.  As soon as law firms are brought into the process, information is locked away under lawyer-client privilege, the cost of safety skyrockets and any safety management lessons are delayed until the court case is heard (or not heard) years later.

It should be remembered that the National OHS Model Law was about the law relating to workplace safety not the implementation of safety management.  It is this differentiation that needs to be constantly pushed to the government to avoid workplace safety becoming a management task that cannot be undertaken without a lawyer watching intently over one’s shoulder all the time.

Kevin Jones

New evidence of the risks of using glyphosate

RoundUp and other glyphosate products are herbicides used domestically and commercially.  New evidence supports the calls by the Institute of Science in Society for a ban on the use of these products. 

Scientists pinpoint how very low concentrations of the herbicide and other chemicals in Roundup formulations kill human cells, strengthening the case for phasing them out, and banning all further releases of Roundup-tolerant GM crops

Research that shows an alternate perspective is available through Monsanto’s website.

This type of opinion or science war makes it very difficult for safety professionals to determine appropriate control measures when the evidence fluctuates however, as ever, protect to the lowest common denominator and eliminate the hazard wherever possible.

Chronic disease report

The Australian Institute of Health and Welfare has released a report on the labour force effects of chronic illnesses.  The report, Chronic disease and participation in work,

shows that chronic diseases are associated with more days off work and/or being out of the workforce, and some of the biggest culprits are depression, arthritis and asthma.

The report focuses on chronic illnesses rather the workplace impacts of the illnesses themselves but there is information that is relevant to how we manage our employees and psychosocial hazards.  For instance the report says

Arthritis, asthma and depression were associated with 76% of the total loss due to days away from work (29% associated with depression, 24% with arthritis and 23% with asthma).

For people participating full-time in the labour force, there was a loss of approximately 367,000 person-years associated with chronic disease, approximately 57,000 person-years in absenteeism associated with chronic disease and 113,000 person-years were lost due to death from chronic disease.

The report acknowledges that any estimates of loss are underestimated and also provides very useful data on chronic diseases and absenteeism

Loss due to absenteeism from full-time and part-time employment was calculated as the difference between the number of days off work for people with chronic disease, and the number expected if age and sex-specific rates of absenteeism among people without chronic disease applied.

The loss from absenteeism associated with chronic disease was approximately 500,000 days per fortnight. This was equivalent to approximately 13.2 million days per year or 57,000 person-years of full-time participation (assuming 48 working weeks of 5 days duration with 10 public holidays per year).

About two-thirds of this cost was carried by males, and people aged 35-44 and 45-54 years accounted for the majority (75%) of lost days.

Analysis of absenteeism by specific chronic disease showed that depression, arthritis and asthma were associated with around 76% of days away from work.

Union influence on OHS – interview with Professor Michael Quinlan

Professor Michael Quinlan of the University of New South Wales believes that the influence of Australian trade unions in improving OHS conditions should not be underestimated or past achievements, forgotten.  

In talking with Kevin Jones in a recent podcast, Quinlan said that the persistent accusation of unions using OHS as an industrial relations tool is “largely an ideological beat-up”.  Although he does believe that Australian trade unions have not pursued workplace hazards to the extent they should have, even with the impeding launch of a campaign on cancers. 

Professor Quinlan mentioned that

“most health and safety management systems are, in fact, largely management safety systems.  They not deal a lot with health….. Their KPIs [Key Performance Indicators] are always expressed in terms of zero-injuries or zero-harm.”

 He also emphasised that that more Australian workers are killed as a result of occupational disease than injury.

He also addresses the growing demand for occupational health and safety regulation to move from industrial relations to the area of health.  Quinlan believes this will never happen because matters to do with employment, organisational restructuring and others have an OHS impact.  He says that running OHS as “an entirely separate agenda…is intellectually and factually flawed.”

Quinlan acknowledges the argument that Robens-style legislation was relevant for the time and where union-presence persists but he said

“where you don’t have effective or worker input, you will have serious problems with health and safety”.

He reminded us that Roben’s also advocated self-regulation, a concept of which there is now great suspicion in a range of business areas.

Quinlan spoke highly of some of the initiatives of OHS regulation, for instance, the adaptation of the inspectorate to duty-of-care matters and a broader operational brief. He also said that the current OHS legislation in Australia “is the best we’ve ever had” and believes some of the recent criticism needs to be supported by evidence.  Also none of the critics have proposed a viable alternative.

Professor Quinlan is a keynote speaker on Day 3 of the Safety In Action conference.

Kevin Jones

Note: the author assists the Safety Institute in the promotion of the Safety in Action conferences.

Eliminate the hazards

The first control measure on the “hierarchy of controls” is to eliminate the hazard.  OHS consultants and professionals should always consider ways to achieve this.  It may prove to be impractical, or politically unpopular, but it should always be discussed or recommended.  Reports and submissions that do not consider this control measure can be considered invalid.

In late-January 2009, the organic farmers in Australia reminded the media that its farming members are developing a safer industry for the customer and the producer.  This industry has boomed in Australia since the 1970’s in as a result of a desire and commitment to “eliminate the hazard”.

Interviews conducted by Biological Farmers of Australia (BFA) to help  discover why producers ‘go organic’ reveal a high number of farmers consider the switch for the health of themselves and their families.

Rob Bauer (Bauers Organic Farm, Qld), one of Australia’s largest organic horticultural growers, says he turned to organic farming 27 ago after farmers in his area became ill with cancer.

He says he wanted to decrease health risks associated with synthetic farm chemicals.

“I started thinking about farming differently after growing up in the Lockyer Valley (Qld) where friends and family passed away in their fifties after years of intensive agrichemical production.”

He says neurological problems, tumours, and cancer were among the chronic diseases he watched take their toll on his local farming community.

“I wasn’t comfortable with producing food using harsh farm chemicals for consumers,” he says.

Steve Skopilianos, commercial lettuce producer from Ladybird Organics in Keilor (Vic) looked into organics when he started a family.

“We had been applying pesticide blends with no understanding of their effect on people and employees.  There were times prior to organic conversion where I would not take my own produce home for my family to eat.”

Biodynamic producers of macadamias are happy to avoid high levels of agrichemicals typically used on the nuts.

“Working without a high exposure to synthetic chemical farm products is a weight off your mind,” says Marco Bobbert, from Wodonga Park Fruit and Nuts macadamia plantation (Qld), certified biodynamic since 1987.

He says direct chemical exposure could easily occur on conventional farms from accidents in production. “All it takes is a broken spray pipe.”

He says it is not just organic farmers who are concerned – “All farmers try to minimise their contact with chemicals on-farm. But organic production actively works toward negating that risk”.

Research has shown there is good reason for producers’ concern – a high exposure to some farm chemicals can lead to major health problems.

Particularly problematic substances include organophosphate insecticides and pesticides, which have been connected to several types of cancer, sterility and cognitive deficits (1).

The agrichemical endosulfan is one example of a highly toxic  organochlorine cyclodiene) insecticide still in use in Australia.

1. (1) Ciesielski, S, Loomis, D, Rupp Mims, S, Auer, A, Pesticide Exposures, Cholinesterase Depression, and Symptoms among North Carolina Migrant Farmworkers; American Journal of Public Health, 1994.

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