“Best Practice…First Aid”? – not sure

First aid is one of the most neglected areas of workplace health and safety but, when required , vital.  The neglect comes from it rarely being integrated into the safety management system and on relying of the advice from first aid training and equipment suppliers.  “Why shouldn’t it be relied on?  They’re the experts.”

In a previous career I worked for a first aid equipment and training provider in various roles.  A major task was to visit workplaces and assist them in determining their first aid needs.  Over the years that I undertook this role I came to the general conclusion that first aid kits were almost always over stocked in comparison to what was needed. (Assessing the first aid needs of 28 McDonalds restaurants in 2 days was fun, at first)

In relation to first training, most companies had insufficient first aiders and those they had were trained fair beyond the needs of their workplaces.

Granted most of these workplaces were not high risk organisations or in isolated locations,  mostly they were in urbanised areas.  But it was also this fact that generated most of the oversupply of equipment.

I was reminded of my many years in that role in the 1990s when SafeWork SA announced the release of its “Approved Code of Practice for First Aid”. (The Code will be available on the SafeWork SA website in a couple of days, and I will review it then)  This Code comes into effect on 10 December 2010 which means a busy 12 months for most South Australian OHS professionals.

According to SafeWork SA’s media statement, the new Code:

  • provides a more contemporary and best-practice approach to first aid
  • gives workplaces more flexibility to tailor their first aid arrangements to suit their type of business
  • better aligns South Australia with provisions interstate.

SafeWork SA’s Executive Director, Michele Patterson, says

“An extensive two-year consultation by SafeWork SA revealed that existing workplace first aid kits were often too big, not relevant to the individual workplace needs, and resulted in considerable wastage……”Under the new Code, first aid kits can be smaller, will cover more types of injuries and should reduce wastage.”

The capacity for tailoring first aid kits to the needs of the workplace has been allowed in Victoria for almost twenty years.  New packaging and configurations were designed by suppliers,  – cloth pouches, wall-mounted plastic boxes, back packs…   But the contents and packaging was determined in relation to the manufacturers costs, more than the needs of the client.

Here is my first aid kit.  A pair of disposable gloves, a disposable resuscitation faceshield, a ziplock bag to keep them in and a mobile phone.  Everything else should be determined by need.

If you don’t remember that first aid is “emergency medical treatment”, you will be ripped off by equipment providers.

Of course it is possible to provide first aid without even this amount of equipment.  The above package is purely personal protective equipment to stop infectious liquid passing between the injured and the first aider.  There are plenty of cases of people who have no access to this PPE still saving lives.

Patterson says that a benefit of the Code is that it brings South Australia’s first aid training levels up to the standards of the other States.  This is relevant for some workplaces but most will wait to see what the national OHS harmonisation process produces and then apply that.

But Patterson says something that holds more wisdom than she expected.

“The more people trained in basic first aid who may be able to keep a person alive until an ambulance arrives – the safer both our workplace and communities will be.”

Here is the core of first aid.  The skills are basic, usually stop the bleeding and keep someone breathing.  I used to refer to this as “plug them and puff them”.  If a first aider achieves these two aims on an injured person until an ambulance arrives, they are fulfilling their tasks.

The other vital element is “until an ambulance arrives”.  Most workplaces are in urbanised locations with good emergency response.  Victoria has a targeted ambulance response time of around 15 minutes and over the last couple of decades the ambulance service has been supplemented by emergency medical services from the fire brigade.

Too many workplace first aid courses teach people how to immobilise a broken leg.  In most circumstances, a broken leg will be treated by ambulance officers.  Only yesterday a high school student attending an end-of-school function broke their nose.  The supervising teacher did the correct action and called an ambulance.  I am sure the boy’s parents also supported the decision.

Companies may consider the skills gained from a five-day first aid training course to be worthwhile for those employees who have children or bushwalk but in relation to workplace first aid, they were overtrained.  First aid courses have been trimmed from the standard workplace first aid course of fifteen years ago but as long as one signs up to an off-the-shelf training course, there will be training elements that are not required.

The last nugget of wisdom from Michele Patterson’s statement above is that the more people trained the better.  Imagine if everyone on one office floor were training in basic first aid.  There would always be a first aider present in the workplace, regardless of the hours of work.  No juggling of this level first aider and that level, or training additional people to cover the absences of the designated first aiders.  The emergency first aid response would the fastest possible and therefore the survival rate would be the best achievable.

Teach everyone in the workplace to “plug them and puff them” and you will be looking after your own health too.  For if you keel over and stop breathing, you will have at least one first aider at your side within a minute.  More likely you’ll have more than one and two-person CPR is very effective.  In this circumstance “reasonably practicable” may increase the level of first aid response rather than diminish OHS standards as it usually does.

It is also worth considering what provides the best first aid coverage in your workplace one first aider trained to a high level (who may be away on the day they’re most needed) or five first aiders trained only in CPR.  The cost would be about the same but which scenario provides the better emergency response and which scenario is more likely to provide compliance.

Kevin Jones

UPDATE – 11 December 2009

SafeWorkSA has identified the August 2009 First Aid Code of Practice on its website as the version which will apply from 10 December 2010.

New guidelines on aggression in health care

WorkSafe Western Australia and the other OHS regulators in Australia have produced a very good, and timely, guideline for the “Prevention and Management of Aggression in Health Services“.

The hazard has existed for many years and hospitals, in particular, are torn between the competing priorities of keeping their staff safe and maintaining  contact with their clients.   Glass screens and wire are effective barriers to violent attacks but it can be argued that such structures encourage aggression by implying that “violence happens here”.

The guidelines, or what the regulators call a “handbook for workplaces” (How does that fit in with the regulatory hierarchy for compliance?), provides good information on the integration of safe design into the health service premises.  But as with most of the safe design principles, as is their nature, they need to be applied from initial planning of a facility and so, therefore, are not as relevant to fitting-out existing facilities.  In health care, it often takes years or decades before upgrades are considered by the boards and safe design is still a new concept to most.

Another appealing element of the guide is that it does not only consider the high customer churn areas such as casualty or emergency.  It is good to see the important but neglected issue of cash handling mentioned even in a small way.

Another positive is the handbook includes a bibliography.  This is terrific for those who want to establish a detailed understanding of the issues and the current research.  For the OHS regulators, it allows them to share the burden of authority.  Just as in writing a blog, by referencing source material the reader understands the knowledge base for the opinions and the (blog) writer gains additional credibility by showing they have formed opinions and advice from the most current sources.

Having praised the bibliography, it is surprising that of all the Claire Mayhew publications and papers mentioned her CCH book “Guide to Managing OHS Risks in the Health Care Industry”, was omitted.

The regulators have often had difficulty determining whether checklists or assessment forms should be included in their guidances.  In Victoria one example of the conflict was in the Manual Handling Code of Practice that included a short and long assessment checklist.  Hardly anyone looked beyond the short version and many thought this undercut the effectiveness of the publication.

The fact is that safety management takes time and business want to spend as little time on safety as possible but still get the best results.  Checklists are an audience favourite and contribute to more popular and widely read guidelines, and broad distribution of the safety message is a major aim.

Interestingly amongst the checklist in this health services aggression publication a staff survey has been included.

(At least) WorkSafe WA has listened to the frustrations of readers who download a PDF version but then have to muck about with, or retype, the checklists.  This handbook is also available as an RTF file for use in word processing.

This is the first OHS publication that has come out from a government regulator with this combination of content, advice and forms.  It is easy to see how this will be attractive to the intended health services sector.

Kevin Jones

News on Australia’s OHS model Act

Safe Work Australia (SWA) has released the latest communique following the Workplace Relations Ministers’ Council meeting on 9 December 2009.  Various amendments have been made to the draft Act following the public submissions period.  Those amendments that SWA consider significant are:

  • adoption of the definition of ‘officer’ in accordance with the Corporations Act 2001 and the definition of ‘due diligence’ to clarify officers’ duties
  • a duty for the persons conducting a business or undertaking (PCBU) to consult not only with workers directly affected by the health and safety matter, but with other duty holders who have a duty in relation to the same matter
  • the requirement for a PCBU to provide training to a health and safety representative (HSR) within three months of a request for training
  • removal of compensation orders as a sentencing option
  • removal of requirements for union right of entry which are already prescribed under the Fair Work Act 2009
  • restructuring of the most serious category of offence to a reckless endangerment offence when a duty holders’ conduct has exposed a person to a risk of death or serious injury of another person
  • monetary penalties, not penalty units, used to ensure consistency between jurisdictions
  • a 14 day timeframe for commencing negotiations between a PCBU and workgroup
  • allowing a PCBU to refuse entry on ‘reasonable grounds’ to a person chosen by the HSR to provide assistance, if no relevant assistance could be provided by the nominated person
  • being subject to a criminal penalty regime, except in relation to right of entry offences in Part 7. Right of entry offences in Part 7 would be subject to a civil penalty regime consistent with that in the Fair Work Act 2009. A framework will need to be established for civil penalties, and
  • penalties for the non-duty of care offences for corporations, ranging from a maximum of $500 000 for serious breaches to a maximum of $10 000 for minor administrative breaches.

Significantly, all the submissions that pushed for the inclusion of a “suitably qualified” OHS professional seem to have missed out.  Clarification or confirmation of this is being sought from Safe Work Australia.

Kevin Jones

UPDATE – 11 December 2009

The Model Work Health and Safety Act has now been posted on the Safe Work Australia website and is available for download HERE

Managerial federalism?

There are some OHS professionals in Australia who follow the harmonisation of the country’s OHS laws closely.  The current status is that the various public submissions are being analysed and discussed by the Government.

But for those who are hankering for some pre-Christmas reading the New South Wales Parliament has released a report called “Managerial Federalism – COAG and the States” written by Gareth Griffith.  This is not a report about OHS, although the topic does get a brief mention on page 25.

OHS harmonisation is perhaps one of the simpler reform processes compared with tax or the legal sector.

The report provides a very good summary of the various consultative structures that the Federal and State Governments operate within as the country changes to a process of “managerial federalism”.  The report summary defines “managerial federalism” as

“…defined to be administrative in its mode of operation, pragmatic in orientation, concerned with the effective and rational management of human and other resources, and rich in policy goals and objectives.  The States play a creative and proactive part but are, to a substantial degree, service providers whose performance is subject to continuous scrutiny and oversight.”

(“Rational management”?  Has everyone in the Australian government been told to read the book by Kepner and Tregoe?  Let’s hope it’s not the 1965 edition.)

Being familiar with some of the concepts and rationales in the report may help those lucky enough to be consulted on government decision-making to know their place in the wild scheme of bureaucratic policy-making.  It may even prove invaluable if you are the safety coordinator on one of the Governments’ many infrastructure projects.

Kevin Jones

Formaldehyde upgraded to human carcinogen

On 4 November 2009, the United States’ National Toxicology Program (NTP) upgraded formaldehyde to a “known human carcinogen”.  This widely used chemical, principally in wood products, has been suspected of being carcinogenic for some time.

The suspicion was a major reason why, in Australia, Comcare issued a cautionary safety alert on using some shipping containers as converted accommodation.  But the Comcare advice was based, and reasonably so, on a manufacturers’ material safety data sheet (MSDS).

One such MSDS selected at random from the Australian internet sites has this to say about formaldehyde:

Reported fatal dose for humans: 60-90 mL

Oral LD50 (rat): 800 mg/kg

Inhalation LC50 (rat): 590 mg/m3

Low concentrations of formaldehyde may cause sensitisation by skin contact. Formaldehyde vapour is irritant to mucous membranes and respiratory tract. Asthma like symptoms have occasionally been reported following inhalation.

Animal studies have shown formaldehyde to cause carcinogenic effects. In particular, chronic inhalation studies in rats have shown the development of nasal cavity carcinomas at 6 and 15 ppm. These cancers developed at concentrations which produced chronic tissues irritation and would not be voluntarily tolerated by humans. [IPCS Environmental Health Criteria 89, Formaldehyde, World Health Organisation [WHO], Geneva, 1989.]

Some positive mutagenic effects have been reported for formaldehyde. Available animal data do not show embryotoxic or teratogenic effects following exposure to formaldehyde.

The NTP notes that formaldehyde effects have now been identified as having a role in leukaemia and not just localised inhalation-related cancers.

The MSDS is dated 2004 and Australian OHS legislation only requires MSDS to be updated at five-yearly intervals.  Of course they can be updated more frequently should the employer chose or, perhaps if the manufacturer advises them of a reclassification.

It is interesting that a 2004 MSDS still refers to WHO data that is fifteen years old and that the reference is to a non-Australian criterion.  It is accepted that chemical reclassification and research are long processes but what should the updating timeline be now that the US has made this significant re-categorisation?

Perhaps the Australia classifications will gain speed given that the more compatible European re-categorisation of formaldehyde, and other chemicals, was announced overnight.  The EU-OSHA website states

“Formaldehyde was confirmed as carcinogenic to humans. There is sufficient evidence in humans of an increased incidence of nasopharyngeal.”

However the human leukaemia issue was discusses in the evaluation summaries:

“The Working Group was almost evenly split on the evaluation of formaldehyde causing leukaemias in humans, with the majority viewing the evidence as sufficient for carcinogenicity and the minority viewing the evidence as limited.  Particularly relevant to the discussions regarding sufficient evidence was a recent study accepted for publication which, for the first time, reported aneuploidy in blood of exposed workers characteristic of myeloid leukaemia and myelodysplastic syndromes with supporting information suggesting a decrease in the major circulating blood cell types and in circulating haematological precursor cells.  The authors and Working Group felt this study needed to be replicated.”

Given that wood products that contain formaldehyde are used frequently in cabinet-making it is fair to expect MSDSs and OHS guidances on hazardous substances and wood dusts would be reissued and databases updated fairly quickly.  Just as important is the fact that particle boards are commonly sold in hardware and timber outlets in Australia and that Spring and Summer is often the DIY peak.

It is not hard to picture an unscrupulous media outlet generating a panic about the presence of formaldehyde in these products regardless of how the chemical is bound or whether inhalation risks are minimised.

Kevin Jones

OHS criticism needs to aim “at the source”

The e-Editor for the Institute of Occupational Safety & Health, Shaun Gibbons, has commented on the recent speech by David Cameron, the Opposition Leader of England’s Conservative Party.

In this editorial Gibbons says

“Instead of cosying up to the newspapers which perpetuate the myths that somehow health and safety is to blame for much of society’s ills, Cameron should be rounding on the media for its part in falsely reporting on health and safety issues.”

If one takes “health and safety” outside the factory fence and consider it as a social attitude or as a collective term for a range of social perspectives, “health and safety” is crucial, or rather the personal fears generated by our concerns for our own health and safety and for those of our family members are a crucial consideration in how we live and work.

David Cameron is a politician and needs the media to distribute his policies and campaign strategies so he is in his natural element.

The print media, principally, does report health and safety issues in an alarming manner but as sensation, and particularly in England titillation, is what sells newspapers, it seems pointless to blame the media for what they have always done.

It will be impossible to get the media to change their attitudes to health and safety.  The struggles of Australian OHS regulators in doing so has been touched on elsewhere in SafetyAtWorkBlog.  It seems clear that if traditional media cannot be changed in this area, alternate media outlets and mechanisms need to be produced that provide information that is not adequately or appropriately covered elsewhere.  This blog is one example.  IOSH’s website is another.

Gibbons gets closer to the core issue elsewhere in his editorial:

“…seeing through the predictable soundbites which came from his speech last week, Cameron has actually highlighted an important cultural issue that IOSH does welcome: people’s growing confusion and damaged confidence when it comes to managing day-to-day risk. With the fear of litigation at the heart of this debate, the speech did give IOSH the opportunity to make its call for us all to move away from a culture of blame to one that’s based on better ‘risk intelligence’.”

He is right in saying that society has an (increasingly) skewed perception of “day-to-day risk” but he is more correct when identifying that

“the fear of litigation [is] at the heart of the debate.”

IOSH and other safety professional organisations need to get a better understanding of the insurance and legal industries so that they are able to temper some of the extremism from these sectors that is sacrificing long-term cultural and societal health for short-term gain.

SafetyAtWorkBlog’s editor, Kevin Jones, wrote in National Safety magazine about the pernicious growth in the expansion of directors’ and officers’ liabilities insurance policies to cover the legal expenses AND fines from OHS prosecutions.  Either safety organisations are unaware of the impact of these products, do not understand them or do not care, as the silence has been deafening.

Kevin Jones

Recent WorkSafe Victoria prosecutions

Over the last two weeks, WorkSafe Victoria has released over a dozen reports and summaries about prosecutions over OHS breaches.  Some have been highlighted in SafetyAtWorkBlog posts but there are too many for us to cover in detail or to expand upon.

Below is a list of those prosecution summaries

A Bending Company Pty. Ltd. – 8/12/09
Summary: Crush injury

Compass Recruitment Australia Pty Ltd – 8/12/09
Summary: Unguarded Plant/Labour Hire

McCain Foods (Aust) Pty Ltd – 7/12/09
Summary: Lack of isolation procedures, instruction and training

Barro Group Pty. Limited – 7/12/09
Summary: Fatality (crush injury) and a failure to provide and maintain for its employees, a safe working environment that was without risks to health.

Alan Mance Motors (Melton) Pty Ltd – 1/12/09
Summary: Explosion

Victorian State Emergency Service Authority – 30/11/09
Summary: Fatality, Volunteers, Employer, Drowning

Dynamic Industries Pty Ltd – 25/11/09
Summary: Fall from height – Fatality

The Inflatable Event Company Pty Ltd – 25/11/09
Summary: Failure to inform, instruct, train and supervise

Transglobal Shipping & Storage (Vic) Pty Ltd – 25/11/09
Summary: Forklifts, Failure to comply with a Prohibition Notice

Andrew Irvine – 25/11/09
Summary: Fall from height – fatality

Canningvale Timber Sales Pty Ltd – 25/11/09
Summary: Unguarded Plant

John Mavros – 25/11/09
Summary: Unguarded Plant

Shane Grigg -v- The Precast Company Pty Ltd – 16/11/09
Summary: Fail to provide suitable employment

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