Heimlich maneuvre has no scientific evidence

The Heimlich manoeuvre is an established first aid technique for removing a blockage, commonly from food.  First aid courses in Australia do not teach the technique as the evidence for the efficacy of the technique is lacking.  The Australian recommendation is to relax the person so that they can cough and to dislodge the blockage through solid thumps on the back.

First aid instructors need to spend time in almost every first aid class to counter the cultural dominance of the Heimlich manoeuvre.

The Australian Broadcasting Corporation’s “The Health Report” investigates the evidence for and against the Heimlich manoeuvre with interviews with Dr Henry Heimlich and with one of Dr Heimlich’s critics, his son Peter.  Peter describes his father as a celebrity doctor.

A Wikipedia article on choking includes the following quote from a 2005 article in the Cincinatti Magazine:

“According to Roger White MD of the Mayo Clinic and American Heart Association (AHA), “There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in.”

The relevance of this podcast is very important for OHS professionals as an indication of the competence and validity of first aid training providers.

The podcast also raises other relevant issues concerning evidence-based decision-making, the manipulation and power of the media, and the credibility of subject-matter experts.

The podcast is a fascinating medical tale, a family saga and, perhaps, a case study for media students, but mostly as a precautionary tale for OHS professionals.

Kevin Jones

Three OHS case studies

The South Australian Industrial Court made three decisions in late July 2009 that are useful cases to look at in order to promote improved health and safety practices but also, in one particular case, to note the approval and endorsement of the judge in the post-incident actions of the employer.

As the SafeWork SA media notice states

“All received 25 per cent discounts from their fines in recognition of their guilty pleas, cooperation, contrition and remedial action to improve their safety systems.”

Case 1

“Bluebird Rail Operations Pty Ltd was fined $30,000 over an incident at its Kilburn workshop in March 2007.  A worker’s arm was crushed beneath a 1,500 kilogram sidewall, which broke loose when a lifting lug failed as it was being lifted to a rail freight wagon under construction.

The court heard that SafeWork SA’s investigation revealed deficiencies in the equipment used, the work processes and the communication channels.

While the worker suffered permanent and debilitating injuries, his employer provided ongoing support including education and training. The employee returned to work after several months and has been promoted within the organisation.”

This case reports a surprisingly short rehabilitation period for a crushed arm.  The words of Magistrate Lieschke should be of considerable note to those OHS professionals who want their clients and companies to go beyond compliance.

“I accept that Bluebird Rail facilitated Mr Sewell’s return to work, in accordance with its legal obligations to provide vocational rehabilitation.  I accept that Bluebird Rail has gone beyond its minimum legal obligations and has provided further re-education support to Mr Sewell, sufficient for him to complete a Diploma in Project Management and for him to now be studying an engineering degree at university. The degree course is being funded by Bluebird Rail.  That is commendable support. Mr Sewell has been promoted and is now working as an assistant project manager.”

Case 2

“International Tastes Pty Ltd was fined $20,250 today after an incident in which an employee had his arm caught in the rotating blades of a pasta-making machine at the company’s Glynde premises in January 2007.

The court was told that the employee was taught to operate the machine with the safety guard open, the interlock switch which would have stopped the machine from operating in such cases was not working, and no safety checks or procedures were in place for either the machine or the tasks involved with its use.

The 24 year old victim suffered fractures, lacerations and nerve damage resulting in a number of operations and considerable pain and suffering.  He has since returned to work interstate with a related company.”

Safety professionals constantly argue for interlocks that cannot be bypassed.  This case shows that the relatively young worker suffered considerably from the incident and has moved interstate to continue with his career.

The judgement raises issues of deep concern to OHS professionals in relation to the level of supervision and induction required for workers and the perennial issue of machine guarding.  The judgement reports the circumstances of the incident:

“On 23 January 2007 [Mr B] suffered serious right arm injuries while operating a pasta making machine in accordance with a method he had recently been taught.  He had received on the job training only and was not given the benefit of any written work procedures.  He had been taught to work in close proximity to unguarded rotating blades.

While using a two litre plastic container to collect pasta mix from the machine the container came into contact with the exposed rotating blades of the adjacent mixing bowl, which in turn dragged his right arm into the blades.”

Case 3

“Central Glass Pty Ltd was fined $9,375 having been prosecuted over an incident in February 2007 at its Salisbury factory, where it makes aluminium window components.

Two workers were manually lifting a slippery steel die weighing 95 kilograms to place it in a press.  In doing so, the die slipped crushing the fingertip of one worker and narrowly missing their feet as it fell to the ground from about waist height.

SafeWork SA told the court there were no safety procedures for the task and the injury could have been averted through the use of mechanical lifting gear, which was later purchased.”

This case can relate to the concept that existed for some time in Australia of a “safe lifting weight”.  This concept has been shown to be a myth as it focuses on only one part of the work process and assumes that the particular lift is outside the other lifting actions that a worker may have been performing previously. It also assumes that everyone has a similar lifting capacity.

The judgement of this case provides more detail

“On 16 February 2007 Central Glass Pty Ltd unnecessarily exposed its employee [Mr R] to a risk of serious injury at work.

With the help of another worker [Mr R]was required to manually lift an oily 95kg steel die from ground level and place it in a close fitting slot in a press at about waist height.  While doing so the die slipped and crushed one of [Mr R’s]fingers.  The die then fell to the ground narrowly missing the feet of [Mr R]and of his colleague. [Mr R] suffered a crush injury to the tip of his left middle finger.

Central Glass had not previously carried out any hazard identification and risk assessment process in relation to changing and fitting dies.  It did not have any safe work procedure for this task and did not provide adequate safety control measures such as mechanical lifting assistance.”

Kevin Jones

New old US research into driving and talking

The New York Times has revealed research on the hazards of driving and using mobile phones that was withheld since 2003.   The newspaper understandably focuses on the intrigue that prevented the report from being released but the content of the report has the potential to substantially change how companies “manage” the hazard of their staff using mobile phones whilst driving. Pages from original

The report, obtained through Freedom of Information and made available on the newspaper’s website, was a  substantial project for the National Highway Traffic Safety Administration and, according to NYTimes:

“The research mirrors other studies about the dangers of multitasking behind the wheel. Research shows that motorists talking on a phone are four times as likely to crash as other drivers, and are as likely to cause an accident as someone with a .08 blood alcohol content.”

The full report is available by clicking on the image in this post.

Kevin Jones

New approach to risks of nanomaterials

US research scientists have released a new article about assessing the exposure risk of nanomaterial.  Treye Thomas, Tina Bahadori, Nora Savage and Karluss Thomas have published “Moving toward exposure and risk evaluation of nanomaterials: challenges and future directions“.

Pages from Wiley nano 02Refreshingly they take a whole-of-cycle approach to the materials and, even though, the conclusion is that more research is required, that they are approaching the hazard in this fashion is a very positive move.

They say that nanomaterials will only become an acceptable technology if people understand the risks involved with the products.

“The long-term viability of nanomaterials and public acceptance of this new technology will depend on the ability to assess adequately the potential health risks from nanomaterial exposures throughout their lifecycle.”

This openness by manufacturers has not been evident up to now as the commercial application of the technology is early days.

The researchers advocate two elements to further investigation of nanomaterials.

The first is metrology and
developing tools to characterize and measure relevant
attributes of nanomaterials, including particle
size, number, and surface area. The second is lifecycle
analysis of nanomaterials in consumer goods
and their transformation and degradation in products
throughout the lifecycle of materials.

“The first is metrology and developing tools to characterize and measure relevant attributes of nanomaterials, including particle size, number, and surface area.   The second is lifecycle analysis of nanomaterials in consumer goods and their transformation and degradation in products throughout the lifecycle of materials.”

There are several medical articles included on the Wiley Interscience website that may be of relevance but it is heartening to see some interdisciplinary thinking in this field.

Kevin Jones

Driving and talking

The issue of driving while using a mobile is a perennial issue for the media but nothing much changes.  The New York Times on 20 July 2009 carried an article on the latest research which confirms  many previous studies that using a mobile phone while driving increases the risk of an accident.

Pages from 6i17 rawNo US State has banned the practice because social use of mobile phones has become so widespread that any ban is impossible to enforce effectively.

In January 2009, SafetyAtWorkBlog reported on the recommendations from WorkSafe Victoria on the matter.  Even in their guide they would say nothing more than

“recommend that hands free calls be kept to a minimum”.

At some point for most workplace hazards, the evidence outweighs the enforcement difficulties and bans ensue.  It has happened to asbestos, it has happened with smoking, but these are decades after dancing around the most effective control measure – elimination.

Pages from 6i02 v4The industrialised world, in particular, has been wrestling with the hazard of phones and driving for well over a decade.  One report from 2002 said

“Tests carried out by scientists at the Transport Research Laboratory established that driving behaviour is impaired more by using a mobile phone than by being over the legal alcohol limit.”

The footnote to this comment said

“Previous research has shown that phone conversations while driving impair performance. It was difficult to quantify the risk of this impairment because the reference was usually made to normal driving without using a phone. “Worse than normal driving” does not necessarily mean dangerous. There was a need therefore to benchmark driving performance while using a mobile phone to a clearly dangerous level of performance. Driving with a blood alcohol level over the legal limit is an established danger.”

There are always conditions set with research findings but these are sensible and valid.

Pages from 3i13According to a 2004 report by the US National Highway Traffic Safety Administration reported by UPI (unable to find a link)

“…estimated 8 percent of all motorists — about 1.2 million drivers — were using cell phones at any given time while driving, up from 6 percent in 2002 and 4 percent in 2000. About 800,000 of those drivers used handsets and not hands-free devices.

  • Handheld cell phone use increased from 5 percent to 8 percent among drivers aged 15 to 24 between 2002 and 2004.
  • Use of cellular-phone handsets increased from 4 percent to 6 percent of female drivers, while the number of men talking on handheld cell phones while driving remained constant at 4 percent.
  • Motorists were more likely to use a cell phone while driving alone, but drivers with children in the vehicle were just as likely to use the phone as those without children in the car.”

For those readers who like dollar figures, the same UPI article stated

“A 2002 study by the Harvard Center for Risk Analysis, part of Harvard University’s School of Public Health, found drivers using cell phones caused 1.5 million accidents annually resulting in 2,600 deaths and 570,000 injuries.

Researchers estimated banning cell phone use in vehicles would cost $43 billion a year in lost economic activity.”

Pages from 2003-119[The only HCRA report on the website is is a 2003 study – Cohen, J.T. and Graham, J.D. A revised economic analysis of restrictions on the use of cell phones while driving. Risk Analysis. 2003; 23(1):5-17.]

A September 2003 report from NIOSH lists a range of driver hazards related to work activities and is worth downloading.  Pages 51-555 deal specifically with phone use.

(If any reader knows of a literature review on this topic, please contact SafetyAtWorkBlog)

This workplace hazard has been around for so long that in the opinion of SafetyAtWorkBlog, when someone is driving a work vehicle 100% of their attention should be on the principal task at hand – driving.

Achieving this realistic aim can be helped by

  • not passing on mobile phone numbers when one knows the person is driving.  The low tech alternative of taking a message works.
  • having employees turn off the phone while driving. (The phone does have an OFF switch)
  • not fitting workplace vehicles with hands-free units.
  • reminding employees of the safe driving policies of the business; and
  • enforcing those policies so that employees know that dangerous acts will not be tolerated or compensated by the company.

Above all, employees must be informed of the risks involved with distraction, must be reassured that employers will support safe actions, and must realise the affect on other drivers and their families from their own mistakes.

Kevin Jones

Maintain instead of repair

Every country has its share of high-fliers who “burn out”.  Many fade away from the public eye with their careers over.  Frequently this path to wealth and prominence is not perceived as a workplace health or safety matter.  Some people decide that the health trade-off of multi-million dollar salaries is worth it.

Sadly the psychological reality of this personal decision is often masked by clichés.  Frequently, executives say that a major motivation for their decision is “to spend more time with my family”.  Many executives may believe this to be a major part of their decision, but regrettably, this worthy sentiment has become a cliché – the equivalent of a beauty pageant winner working toward “world peace”.

The family-time phrase/reason/excuse signifies an important element of the executive’s personality.  They were willing to sacrifice decades of their relationship with their partner and to be absent from the development of their children for money.

If any of these departing executives use the family-time phrase in the same departure speech or media exit-interview  as regaining “control of their lives” to “re-engage with the most important people in my life”, ask the executives, or politicians, “how do you justify ignoring your family over your career?”.

In some cases one could be more specific.  “Do you think that your multi-million career was related to your daughter’s persistent attempts to kill herself?”  “After being absent so frequently and for so long, are you still justified in describing your marriage as a loving relationship, or your partner as your ‘soulmate’?”  “Was your million-dollar salary really worth it?”

Int he wake of the self-generated corporate financial crisis, some corporate executives are re-examining their ethics and morality.  Not enough are going through this but it’s a start.  Most say they operate for the benefit of shareholders but they cannot deny the reality of massive remuneration for their efforts.  What they are ignoring is the individual cost to their loved ones of these efforts.

Should we look up to the billionaires who sacrifice the wellbeing of others they say they love to chase the dollar?  Are these the paragons of our society?

People are trying to maintain or establish a work/life balance.  (There are several articles at SafetyAtWorkBlog that report on this movement.)  But the reality is that to achieve a work/life balance, one must be prepared to sacrifice income.  This may involve the necessity of achieving a certain stage in one’s career that is not the top, but still a position of value in the company and, equally important, of value to one’s family and even one’s own psychological well-being.  If one’s colleagues fail to understand this decision, the workplace culture is faulty, and probably irreparable.

If the ultimate ideal is to have a happy, functional, and sustainable community, one must examine one’s own motivations, and one’s own personal priorities.  Everyone must consider whether we want to emulate those who sacrifice their family’s welfare for money or whether we support those who rebut the “glory of the high-achiever” and emulate those who love their family enough to spend time with them through their career.  Maintenance is easier than repair in life as in safety management.

Kevin Jones

Occupational violence in fast food restaurants and petrol stations

The Australian media has been abuzz over the last couple of days on several issues concerning violence.  Attention increases whenever there is video involved and the latest film of a bashing in Melbourne in a Hungry Jack’s store in the early hours of 13 July 2009 is getting a considerable run.

Most commentators are taking the bashing of 19-year-old Luke Adams as an example of “street violence”.  SafetyAtWorkBlog believes that the fact that this event occurred between customers in a workplace, raises questions about the obligations of retail store owners towards health and safety.

The case of Luke Adams again illustrates the reality that surveillance cameras can assist in the apprehension of criminals but does little to reduce the harm to employees and customers.  This seems to be contrary to the OHS principles in Australian OHS legislation.

SafetyAtWorkBlog would ask any retailers who choose to operate, particularly, during nighttime

  • Are the stores designed to reduce (hopefully eliminate) the risk of violent contact between customers and staff?
  • Are there restrictions on the age or gender of staff who work nightshift?
  • Is the first aid training provided to staff designed to accommodate the emergency treatment of severely injured customers?
  • Has the presence of a security guard been tried during nightshifts?
  • Would the company consider closing a store if the risks to staff and customers became unacceptable?

SafetyAtWorkBlog knows of at least one fast food restaurant in Melbourne that removed its public toilets because of the number of drug overdoses that occurred in the cubicles.  This store eventually closed its 24-hour store, partly, because of the unacceptable risk that developed.

The unfortunate linking of fast food restaurants with violent attacks is an issue of all-night trading as much as any other reason.  It was just over two weeks ago that a fight in the grounds of a Hungry Jacks restaurant in suburban Melbourne was reported and wrapped into the current topic of supposedly racist-based attacks against Indian students.

The attacks are not limited to Melbourne though.  A 19-year-old Korean student, Lee Joonyub, was killed in Sydney in 2008 after being stabbed at a fast-food restaurant

AIC Service Station Violence coverThe risk of occupational violence, as it is more traditionally understood, is increasing according to findings released on 16 July 2009 by the Australian Institute of Criminology.  Its report, which also received some media attention from radio, finds that

“The incidence of service station armed robbery has steadily increased over the past decade. ….. This opportunistic targeting of service stations has been attributed to their extended opening hours, their sale of cigarettes and other exchangeable goods, their high volume of cash transactions and their isolation from other businesses. Widespread adoption of crime prevention measures by service stations, such as transfer trays, could help reduce their risk of being robbed…..”

The full report is worth reading closely from an OHS perspective as it identifies the characteristics of services stations (and maybe other all-night retail outlets) that are attractive to the opportunistic robber.  We should not dismiss armed robberies as only involving monetary loss to retailers as the study showed that “one-third of armed robbery victims…were individual”.

The AIC report also states that

“…minimal staffing on night shift is seen to increase the risk of armed robbery victimization for service stations.”

This brings in all the OHS advice and research concerning working alone or in isolation.  However there must be some sympathy for employers trying to recruit night shift workers for industries where violence is an increasing risk.

The mention of the hazard control measure of transfer trays is gratifying as it fits with a higher order of control measure in OHS parlance by providing an engineering control.  However this needs to be backed up by specific training for employees on what to do when required to render assistance outside the enclosed booth.

The application of transfer trays may be valid for fast food stores at nighttime by only offering a drive-thru service and further reducing the risk of customer violence against employees.

Pages from VWAHotspots_retail_10_10Regardless of the physical harm from work tasks arising from working in retail, WorkSafe Victoria advises of four control measures for what it describes as the psychological system of stress, bullying and harassment:

  • Your workplace culture and management should encourage open and effective communication.
  • Develop, implement and enforce clear policies and procedures that address bullying, occupational violence, harassment and work pressure in consultation with workers (including young workers) and management.
  • Where money is handled, put in place security measures to reduce the risk of occupational violence.
  • Training and procedures should include all staff at risk, including any casual or on hire workers.

Kevin Jones

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