A matter of life or death

When you hear about someone who died of a heart attack at work, do you ever wonder whether the employer had a program in place that would enable a trained co-worker to administer cardiopulmonary resuscitation (CPR) until medical help arrived? Was a defibrillator available, and was someone trained to use it?

Some people asked these questions when they heard about the death of journalist Tim Russert, who died from a heart attack in his Washington office. Reportedly, the staff called 911, administered CPR, and were preparing to use the defibrillator when emergency medical help arrived. Three attempts to shock Russerts heart back to life failed. Having a good first-aid program doesnt always prevent death, but in many cases, it can and does. Appropriate first aid also can make the difference between no or extreme damage caused by lack of oxygen to the brain.

The U.S. Occupational Safety and Health Administration (OSHA) reports that of the 220,000 cases of cardiac arrests that occur each year, 10,000 occur at work. According to OSHA, doing nothing while waiting for emergency medical personnel to arrive results in only a 5 percent to 7 percent survival rate. Studies show that people who receive immediate defibrillation show up to a 60 percent survival rate one year after cardiac arrest.

Program Justification

It makes good business sense to have at least a basic first-aid program that can provide adequate assistance to an injured or ill employee until medical help arrives. Occupational illnesses, injuries, and fatalities in 2004 cost the U.S. economy $142.2 billion, according to National Safety Council estimates. The average cost per occupational fatality in 2004 exceeded $1 million To cover the costs to employers from workplace injuries, each and every employee in this country would have had to generate $1,010 in revenue in 2004.

Common sense says that workers feel more comfortable and tend to be more productive when they know that proper equipment and trained individuals are available should an injury or event such as a heart attack occur on the job.

Programs Are Mandatory for Some

OSHA mandates on-site first-aid provisions under certain circumstances. Its First Aid standard (29 CFR 1910.151) requires trained first-aid providers at all workplaces of any size if there is no "infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees."

In addition to the first-aid requirements of 29 CFR 1910.151, several OSHA standards (1910.146, 1910.266, 1910.269, 1910.410, and 1926.950) also require training in CPR because cardiac arrest from asphyxiation, electrocution, or exertion may occur.

If an employee is expected to render first aid as part of his or her job duties, the employee is covered by the requirements of the Occupational Exposure to Bloodborne Pathogens standard (29 CFR 1910.1030). This standard outlines specific training requirements.

"The Best Practices Guide: Fundamentals of a Workplace First-Aid Program," an OSHA-created document intended to help employers establish a first-aid program, defines first aid as emergency care provided for injury or sudden illness before emergency medical treatment is available. The first-aid provider in the workplace is someone who is trained in the delivery of initial medical emergency procedures, using a limited amount of equipment to perform a primary assessment and intervention while awaiting arrival of emergency medical service (EMS) personnel.

According to the publication, a workplace first-aid program is part of a comprehensive safety and health management system that includes management leadership and employee involvement, worksite analysis, hazard prevention and control, and safety and health training.

Basic Elements

The basic elements of a workplace first-aid program are identifying and assessing the workplace risks that have potential to cause injury or illness and designing and implementing a program that:

• Aims to minimize the outcome of accidents or exposures.
• Complies with OSHA requirements relating to first aid.
• Includes sufficient quantities of appropriate and readily accessible first-aid supplies and first-aid equipment, such as bandages and automated external defibrillators (AEDs).
• Assigns and trains first-aid providers who:
  • receive first-aid training suitable to the specific workplace.
  • receive periodic refresher courses on first-aid skills and knowledge.
• Instructs all workers about the first-aid program, including what workers should do if a co-worker is injured or ill. (OSHA recommends putting the policies and program in writing, being sure to address language barriers.)
• Provides for scheduled evaluation and modification of the first-aid program to keep the program current and applicable to emerging risks in the workplace, including regular assessment of the adequacy of the first-aid training course.

Supplies

OSHA recommends that an employer assign a specific person the responsibility for choosing the types and amounts of first-aid supplies and for maintaining them. The supplies must be adequate, should reflect the kinds of injuries that occur, and must be stored where they are readily available for emergency access. An AED should be considered when selecting supplies and equipment.

A specific example of the minimal contents of a workplace first-aid kit for a small business can be found in American National Standards Institute ANSI Z308.1 - 2003, "Minimum Requirements for Workplace First Aid Kits."

For large operations, employers should determine how many first-aid kits are needed, and if it is appropriate to augment the kits with additional first-aid equipment and supplies.

Employers who have unique or changing first-aid needs should consider upgrading their first-aid kits. The employer can use the OSHA 300 log, OSHA 301 reports, or other records to identify the first-aid supply needs of their work site. Consultation with the local fire and rescue service or emergency medical professionals may be beneficial. By assessing the specific needs of their workplaces, employers can ensure the availability of adequate first-aid supplies. Employers should periodically reassess the demand for these supplies and adjust their inventories.

Training

The American Heart Association, the American Red Cross, the National Safety Council, and other nationally recognized and private educational organizations offer first-aid training. OSHA does not teach first-aid courses or certify first-aid training courses for instructors or trainees. Courses should be tailored to the needs of the specific workplace.

The OSHA booklet contains a comprehensive listof the elements of a first-aid training program. As noted, some of the elements may be optional for a particular facility, but unique conditions at a specific work site may require adding customized elements to the program.

All training should include testing to assess the trainees first-aid skills. The American Heart Associations Emergency Cardiovascular Care Committee encourages skills review and practice sessions at least every six months for CPR and AED. OSHA recommends that instructor-led training for life-threatening emergencies should occur at least annually. Non-life-threatening response training should occur periodically.

First-aid programs are not to be considered static. They should be evaluated regularly and updated as necessary.

A good first-aid program can make the difference between life or death.