First Aid in the Field

By April Hirsch / Published May 2020

Remain calm. Things happen; we must deal with them.

When a team member is injured or falls ill in the field, the Occupational Safety and Health Administration (OSHA) expects a response. Employees must be trained by employers in a manner commensurate with the likely hazards in their workplace (OSHA standard CFR 1910.151).

First aid never substitutes for professional medical care. It is, however, an essential part of any effort to mitigate consequences of a health-related event. The more serious an incident, the more important time becomes. “First aid preparedness can help the person or persons in need of medical care beyond first aid by providing more time for a medical professional, like EMS, to arrive and take over in what are still critical moments…,” says Leighton Light, the safety engineer at Chappell Supply and Equipment in Oklahoma City, OK.

“Basic first aid knowledge for those in the field is a powerful tool and can save your life,” says Light. With that, it’s the word “first” that must be emphasized, given the expectation there will be follow-up.

“Always be prepared to call 911 for emergency service response,” says Light. “The faster the emergency response is notified, the better.” If it seems that a 911 call is warranted, it is. “It is easier to send emergency services back when not needed than to need them there and not have them on the scene,” says Light.

Part of being prepared to render first aid means knowing how to make a 911 call. “Be ready to describe the situation to the 911 operator,” says Light. “The operator should be able to help guide you if you must act immediately, as well as to help you stay calm.”

Of course, it’s easier to respond to an incident that requires quick thinking when one has been properly trained, and that proper training is what OSHA expects. “National Red Cross and the National Safety Council have great resources that can help you connect to consultants or trainers in your area,” says Light. Each employer will decide on the training approach that works best.

Yet from his perspective, Light does have one strong recommendation. “I believe in hands-on training; it should be part of any first aid training.”

Knowing the many excellent courses CETA provides to members, Light would like to suggest another. “It would be a good idea for CETA to provide first aid training courses,” he says.

A primary issue covered in first aid courses is what to do when a person is unconscious or nonresponsive. (That is in addition to calling 911 immediately.)

The responsiveness versus unresponsiveness dichotomy matters greatly. Sadly, part of the reason for the significance is the need for the person who will render aid to gain consent from the person requiring aid.

Yes, get consent. It’s a litigious society. Applying a belt as a tourniquet may save a life, but if the constriction also causes damage to a limb, the person whose life was saved may look for compensation. (See more about this in the last section.)

Preparedness

From bee and wasp stings to cuts and heat stroke, the list of incidents requiring first aid in the field is a long one. Different work sites will rank the order of what’s most likely to happen differently.

“The most common injury that I see out in the field is ‘busted knuckles’ or bruised knuckles,” says Light. “This injury occurs by a tool’s jaw slipping while working to loosen plumbing, which in turn causes the hand to hit a solid surface, bruising the knuckles on a hand.”

Mindfulness is key to avoiding injury, not just when working with tools but also when setting up. Before setting up a ladder, for instance, do a cursory inspection to make sure it’s not going to upset a wasp’s nest. And do all that’s expected. “Working without proper personal protective equipment (PPE, such as gloves, glasses, hard hats, etc.) can expose you to a variety of hazards and subsequently a variety of injuries,” says Light.

As Light points out, prevention is the best strategy for minimizing the effects of injury or illness in the field. When things do happen, despite the best preparedness and prevention, team members must be able to respond.

Rescue breathing, CPR (cardiopulmonary resuscitation), and use of an AED (automated external defibrillator) are ways of responding to life-threatening situations. Contractors may work in a field setting where CPR certification is a requirement for all members of the team.

Employers must determine the level of first aid training employees require. And then, they must make certain they get it.

At a more fundamental level, OSHA provides guidance about what a basic first aid kit should contain. Among the items are gauze pads, adhesive bandages, gauze roller bandage at least two inches wide, two triangular bandages, wound-cleaning agent, scissors, blanket, tweezers, adhesive tape, and latex gloves.

For those working in remote locations, requirements for kits are more extensive. There are also special requirements in some places, such as eyewash stations and shower equipment when working at a hazardous waste site.

Best Practices Guide: Fundamentals of a Workplace First-Aid Program (www.osha.gov/Publications/OSHA3317first-aid.pdf), a 28-page open-source document, offers a good overview of all that should be kept in mind when developing and maintaining a first-aid program. It’s an excellent and free resource.

The American Red Cross offers a useful guide to locating a first aid class. See www.redcross.org/content/dam/redcross/atg/PDFs/Take_a_Class/WRFA_ERG_9781584806295.pdf.

Prudence

We all aspire to live as a good Samaritan, and we certainly want to be ready to give aid in the field. Caution, though, applies. For one, none of us should take on any intervention that is beyond our level of first aid training. We may have seen someone perform an emergency tracheotomy with a pen knife and a straw on a television program. That does not equip us to do the same.

As noted in the preceding section, the individual who steps in to give aid must ask permission of a conscious person before giving the assistance. Before giving aid to a conscious person, the aid giver must also describe the scope of his or her training.

We wondered what insurers say about the risks to employers and employees if aid is rendered and something goes wrong. It gets quite complicated—so much so that one expert in the insurance industry has a powerful piece of advice about responding to an incident. “Go straight to the medical express or to the emergency room,” says Tom Svrcek, president of CSC Insurance Options and Joseph D. Walters Insurance in Belle Vernon, PA.

Even the most straightforward situation of aid rendered in the field can lead to trouble for a contractor. Consider the impact on workers’ compensation premiums.

What seems a minor event, such as a skinned finger, still ought to be evaluated by a medical professional. Svrcek explains that many contractors worry their workers’ compensation premiums will increase if they send someone to the emergency room or medical express. The premiums probably will increase.

Trying to circumvent a premium increase by paying cash for the employee’s medical care can lead to problems. “It’s all fine until months later when there’s some problem with the finger,” says Svrcek. At that point, the employer cannot turn in a claim, which ultimately may be much more costly to an employer than any increase in a premium.

Liability is an ever-present issue for a business owner. In the context of trying to avoid high workers’ compensation. premiums, Svrcek sees a trend that alarms him. “A lot of small employers say, ‘I think I’m not going to make them an employee, I’m going to make them a 1099 contractor,’” explains Svrcek. “They are taking an awful chance.”

Why? If the employees go to work every day at the direction of the employer and they are using the employer’s equipment, in many states they will be considered employees.

Any change in exposure, such as going from sole operator to hiring one employee, should be tied to a review of insurance needs, says Svrcek. Being properly insured can be a cost savings in the long term.

Tangential, but such a critical reminder that we tackle it here: Svrcek wants contractors to know a factor truly driving up premiums.

“Now insurers are taking a really hard look at Facebook and websites,” says Svrcek. On the sites, contractors often list every type of cleaning imaginable, even if they don’t do it. Some of them also have photos of workers in precarious situations without protective gear.

“This overstatement and photo record is causing a huge problem,” says Svrcek. Instead of a quote for $1000, contractors may instead get a quote for $5000, all because they embellished the scope of their work or used photos that suggested less-than-correct safety methods.

But back to first aid in the field: Know what OSHA requires for training. Train (and retrain). Stress the need for a calm and methodical (by the training book) approach to an incident. Get to a medical facility or call 911 as soon as possible. Never overreach.