Latest guidance on working alone

Western Australia’s WorkSafe has just released its latest guidance on working alone and it is the most practical look at the hazard from any OHS regulator in Australia.Working_alone cover

Importantly, it differentiates between “alone” and “remote”.  In 1995, when the Victorian First Aid Code of Practice raised the issue of isolation, there was considerable confusion.  How can someone in the metropolitan area be isolated or remote?

  • Undertaking an assessment of first aid needs of a multi-storey building which has cleaners or nightshift working at 2am.
  • Working alone in a petrol station in an outer suburb.
  • (Sadly) showing a potential client a new property in a new real estate development on the fringes of the city.
  • Security guard walking the perimeter of an industrial site
  • Delivering pizzas at 3am
  • Home visits from medical specialists

The WA definition of “alone” is very useful and needs to be kept front-of-mind in OHS policy and procedure production.  It could be used in the review process of existing policies and prores to ensure their applicability.

“A person is alone at work when they are on their own, when they cannot be seen or heard by another person, and when they cannot expect a visit from another worker or member of the public for some time.”

The working alone guidance identifies four industry types that require special support for working alone:

  • Agriculture
  • Pastoral
  • Forestry
  • Mining

Although SafetyAtWorkBlog advocates low-tech control options as much as possible (usually because of increased reliability) thankfully this guidance discusses mobile phones, satellite communications, GPS locators and other communications devices.

Kevin Jones

Trained first aiders in “low risk” microbusinesses

WorkSafe contacted me today concerning some issues raised in a previous post concerning their first aid information. Some small tweaks have been made to that post but one point required elaboration.  There is some dispute over whether low risk micro businesses require a trained first aider.   Below is my position.

FIRST AID NEEDS ASSESSMENT

The First Aid Compliance Code discusses a first aid needs assessment.   In our experience of assessing scores of workplaces, large and small, for first aid needs (including over 28 McDonald’s restaurants but that’s another story), we are convinced that a workplace that relies on others to provide an acceptable level of emergency first aid response would expose the employer to avoidable legal issues.   Unless, of course, one relies on “as far as is reasonably practicable” after someone may have been seriously injured or died on your premises.  It is doubtful that the relatives of the deceased would be so forgiving.  (Consider the actions of concerned relatives following the Kerang court case decision.)

Ask yourself, is it better to have a trained first aider on site just in case, or rely on an ambulance being readily available and render no assistance?

Time is crucial in an emergency, with the risk of a person’s condition becoming more serious the longer treatment is delayed.  Emergency ambulances, even in metropolitan areas, can be delayed and, in an emergency, waiting with an unconscious and/or non-breathing person will seem an eternity.  Any delay in rendering appropriate first aid treatment will complicate proving that an appropriate duty of care was applied in the circumstance.

The Australian Resuscitation Council has made its guidelines available online. For those interested in establishing an appropriate level of first aid response for their workplaces, the guidelines are recommended to read.  But more importantly is the need to have suitably trained first aiders on site, particularly after an assessment of the workplace’s  first aid needs has been conducted.  A first aid kit is next to useless if CPR is required.

Of course, the need for first aid is minimised if all the other OHS matters are dealt with first in an orderly safety management system.

Kevin Jones

Flawed first aid information

First Aid Complaince CodeSome time ago WorkSafe Victoria issued Compliance Codes on a number of workplace safety issues.  One was concerning First Aid.  The Compliance Codes were intended to replace Codes of Practice which had been around for decades.

The previous major change to workplace first aid was in 1995 when the First Aid Code of Practice was reviewed in Victoria.  Other Australian States vary between prescriptive and non-prescriptive first aid guidelines.

On 31 May 2009, WorkSafe released a factsheet on first aid for low risk micro businesses.  A low risk micro business is explained in the factsheet as those that

  • employ fewer than 10 people
  • are located where medical assistance or ambulance services are readily available
  • are businesses that don’t expose employees to hazards that could result in serious injuries (eg serious head injury, de-gloving, scalping, electric shock, spinal injury) or illnesses that may require immediate medical treatment.

First Aid for Low Risk Micro BusinessesSome examples of low risk micro businesses were included in the factsheet –  “retail shops and outlets, offices, libraries and art galleries” Why a one page information sheet for this sector was deemed to be needed is a mystery?  I asked WorkSafe several questions about this factsheet

  • What was the rationale for the production of this guidance for this sector? Given that the Compliance Code is specifically referenced.
  • Is retail really a low-risk micro-business?
    • What about the use of ladders?
    • Young workers?
    • Working alone or unsupervised?
    • Occupational (customer) violence?
    • Petrol stations?
    • Convenience stores?
    • Night shift security needs?
    • Knife cuts from removing stock from boxes?
    • Manual handling?
  • First aid kits are required but not first aid training. In the case of respiratory failure a first aid kit is next to useless for CPR.
  • Why is only St John Ambulance referenced on the guidance?

The factsheet misunderstands first aid by placing low risk microbusineses into the “paper-cut” sector.  This is doing micro-businesses a dreadful disservice.

TRAINED FIRST AIDER

Shortly after the First Aid Compliance Code was released St John Ambulance broadcast an email about workplace first aid compliance.  In that email St John wrote:

Low risk organisations (office, libraries, retail etc) should have at least one qualified First Aider for 10 to 50 employees…

The May 2009 fact sheet makes no mention of the need for a trained first aider but WorkSafe’s own Compliance Code states this as a compliance element.

A low-risk micro-business may not generate the potential hazards that WorkSafe lists in its definition above but employees in these businesses do have to respond to the injury needs of their customers.  In these times of public liability and the expansion of OHS obligations to include customers, neighbours, and others who are affected by work processes.

WorkSafe itself describes an employee’s duty of care:

“All workers have a duty of care to ensure that they work in a manner that is not harmful to their own health and safety and the health and safety of others.”

The omission of a trained first aider is unforgivable.  What would an employee do if a client collapses in the foyer of a convenience store with a heart attack or chokes on the food that they have just purchased?  What would one do if a stab victim stumbles into the only open retail outlet, perhaps a petrol station, at 2.00am? How would that petrol station attendant  treat someone who has had petrol accidentally splashed in their face?

These matters cannot be treated by a person who is untrained in basic first aid who only has a first aid kit available.  Training for all workers who work alone or in isolation in micro-businesses is a basic element of compliance, one that WorkSafe fails to list in its latest workplace first aid factsheet.

EMERGENCY NUMBER

Almost as unforgivable is that the factsheet makes no reference to the Australian emergency number of 000.  One of the first actions to be performed in a workplace where someone is seriously injured is to call for an emergency ambulance.  While waiting for the medical authorities, and if safe to do so, first aid should be rendered. WorkSafe needs to remember that CPR requires training and that a first aid kit is next to useless in this type of situation.

ST JOHN AMBULANCE

It is curious that only St John  Ambulance is listed on the factsheet for further information.  There are many first aid equipment and training providers in Victoria.  It would have been fairer to either recommend all providers or none at all.

[UPDATE: WorkSafe has advised SafetyAtWorkBlog that they will be addressign the St John Ambulandce and 000 issues raised.]

COMPLIANCE CODES

On 18 September 2008, the WorkSafe website described the First Aid Compliance Code as covering

“…first aid arrangements including first aid needs assessment, first aid training, first aid kits and first aid facilities.”

In a media statement at the time on compliance codes generally WorkSafe Executive Director, John Merritt was quoted:

“The codes were developed after extensive consultation with industry, employers, employees, governmental agencies and the community to provide greater certainty about what constitutes compliance under the OHS Act.”

“The codes include practical guidance, tools and checklists to make it easier for duty-holders to fulfil their legal obligations.”

Mr Merritt added that: “These codes will provide Victorian employers, workers and Health and Safety Representatives with certainty and assistance in meeting their responsibilities.”

The Compliance Codes are aimed at the many dutyholders yet one of the rationales for the new single sheet guidance is that dutyholders (employers) do not read Compliance Codes.  It seems that the Codes are now principally read by OHS professionals and advisers.

(This position may be one of the reasons WorkSafe is pushing so hard for a truly professional OHS structure through its HaSPA program – the establishment of an OHS middleman between the rules and their application in the real world.)

It is a considerable change to the readership the Compliance Codes were aimed at and is a substantial change from the Codes of Practice which, in the case of First Aid, were handed out to all first aid trainees, included in information kits for health & safety reps, and were read by dutyholders and integrated into their OHS management practices.

The significance of Compliance Codes and Codes of Practice at the moment is that these documents are to be part of the Federal Government’s move to harmonisation of OHS laws.  (Some eastern States have already begun joint publication of guidances). Variations in these documents, often the most referred-to OHS documents in workplaces across the country, will undercut the aim of harmonisation – the reduction of business compliance costs through harmonised OHS requirements.  If the practical application of laws are not harmonised, the aims will never be met and the process could be seen as seriously flawed.

Kevin Jones

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

The reality of First Aid

Many employees undertake first aid training because it is a relatively easy training program to arrange, it is cheap and it provides skills that can be applied outside the workplace.  

But newly trained first aiders often leave training with an unrealistic feeling of empowerment.  Regularly, small businesses regret the disruption caused by the first aider’s evangelism for safety, particularly if the first aider was trained to provide some generalist safety presence in the company.  Similar disruption can result from health and safety representative training and perhaps that is why many small businesses are wary of this.

First aid trainers need to remind students regularly of the reality of first aid.  This reality is shown in the death of a truck driver in an isolated part of Australia on 9 January 2009.  First Aid is a terrific life-saving skill but the reality is that circumstances beyond one’s control may still result in a death.

In a class once, a student asked a first aid instructor what would happen if a farmer was bitten by a snake in an isolated part of the farm and the farmer  had no first aid skills or kit.  The trainer responded, “the farmer would die”.

The reality of living in a large country of isolated roads and small population is shown in the death of the truck driver.

The role of mobile telecommunications in the article is a distraction and relates more to the current political and commercial disputes between the Australian government and the telecommunication providers, than to the truck driver’s injuries.  

The article may lead to discussion on the poor emergency resources in rural and outback Australia.

First aid and emergency response has been revolutionised by mobile phone technology over the last 20 years.  Mobile phones have caused us to find lost bushwalkers and to get emergency ambulances to accident scenes much quicker.  Thankfully, a quicker emergency ambulance response shortens the time needed applying first aid.

It is a truism that no matter how much training we have, or how much technology we can access, death is a reality of life.

Defibrillators in public places

official20portrait_oct07_sm-brumbyThe Victorian Premier, John Brumby, “unveiled” publicly accessible defibrillators at the Southern Cross station in Melbourne on 6 January 2008.  Australia has been relatively slow in the take-up of defibrillators as part of the non-professional first aid role.  Partly this was due to the initial expense of each unit but also because workplace first aid legislation took some time to accommodate technology.

In most States of Australia, this was exacerbated by the emphasis on allocating first aid resources on the basis of need rather than a prescriptive basis and, anyway, how can you gauge where people will have heart attacks?

SafetyAtWorkBlog is wary about relying on technology to solve problems simply because it seems simpler.  In the long-term, technology can be become cumbersome, unnecessarily expensive to maintain and often increasingly unreliable.  It is suggested that a cost/benefit exercise of the new defibrillators in Southern Cross Station would show them to be an unnecessary expense.  Direct cause and effect in terms of first aid is difficult to quantify.  But then again, according to the Premier’s media statement:

“In the 2007/08 financial year, Ambulance Victoria responded to 133 emergency cases at Southern Cross Station, including five cardiac arrest incidents.”

Defibrillators were obviously not applied as quickly in those incidents as can be in the future but for those first aiders in this blog’s readership the following statistic can be quite useful.

“Victoria has the best cardiac arrest survival rate in Australia, with 52 per cent of patients arriving alive at hospital.”

Let’s hope that these defibrillators will stop the Southern Cross Station from being a “terminal”.

Kevin Jones