For instance, every year in the European
Union 8,900 people die from work-related
incidents. In the UK, 156,000 non-fatal accidents
are reported at work each year, and
in the U.S. there are more than 4 million injuries
and illnesses recorded in private
workplaces each year.
As a result of figures like these, greater
emphasis continues to be placed on occupational
first aid. Historically, first aid practices
were developed predominantly on the
battlefield. Many of the skills used today
have evolved from military experience of
dealing with severe wounds and injuries. Indeed,
both the St John Ambulance Association
in the UK and the International
Committee of the Red Cross (ICRC) were initially
set up to deal with casualties of war.
In 1878, two British army officers, Peter
Shepherd and Francis Duncan, took what
they had learned on the battlefield and developed
the first curriculum in first aid,
teaching these skills to civilians. Clara Barton
later founded the American Red Cross,
prompted by her experiences in the American
Civil War and the Franco-Prussian War.
She went on to establish a group dedicated
to instructing workers in industry, where accidents
and fatalities were common due to
dangerous conditions.
Since these early days, first aid practices
have evolved and advanced. New techniques
and equipment have empowered
people with valuable skills previously only
carried out by medics, enabling them to
manage situations effectively until emergency
assistance arrives.
Rapid control of injuries is important in
any situation. When an accident happens,
emergency medical services can be only
minutes away. But on other occasions it
takes longer. It is essential for workplaces to
have trained first aid providers and suitably
stocked first aid kits to deal with emergency
situations.
This is particularly important in industries
such as construction, forestry, mining and
petrochemical, which have a higher risk of
accidents. According to OSHA, at least one
person and preferably more people trained
in first aid must be available at the worksite.
In areas where accidents resulting in life threatening
injuries or illness can be expected,
a three to four minute response time
is required.
In addition to the life-saving skills that
promote breathing and circulation, the abiliity to stop moderate to severe bleeding is
critical. Bleeding is one of the greatest
threats from traumatic injury. It can cause
shock and damage tissue and organs or even
lead to death in less than 10 minutes. Moderate
prolonged bleeding can do the same.
Uncontrolled hemorrhage contributes to
30 to 40 percent of trauma-related deaths
and is the leading cause of potentially preventable,
early in-hospital deaths.
Platinum 10
The first 10 minutes after traumatic injury,
referred to in the army as the “Platinum
10,” forms the basis of a new type of
combat medic training. It is critically important
to stop serious bleeding and stabilize
the person’s condition within this time
period to reduce the risk of life-threatening
complications.
The amount of blood loss directly impacts
survival rates, speed of recovery and
risk of complications in the days ahead.
Without proper first aid, it can be too late
by the time the emergency services arrive.
Effective and immediate control of bleeding
can critically influence the outcome and save lives.
The 2005 guidelines set out by the National
First Aid Science Advisory Board advise
that applying direct pressure to the area
is the most effective way to control bleeding.
International first aid organization St.
John Ambulance also recommends this approach.
When done properly, applying pressure
alone can be successful in controlling
bleeding; however, in severe incidents it is
often not enough. It can take time to work,
during which blood is lost and the response
to other injuries or casualties is delayed.
Blood clotting is the body’s natural
way of closing a wound and preventing
blood loss. The faster the blood clots, the
less blood is lost. In small wounds a clot
can form in a couple of minutes. However,
in larger wounds the normal clotting
mechanism fails to stop the
bleeding.
New Technology
A new generation of first aid products
containing agents that speed up the
blood clotting process has become commercially
available in recent years. The military were one of the first to embrace
this new technology for the treatment of
severe bleeding wounds. However, various
factors have inhibited their success.
Some required surgical skills for application
and were found to be inflexible
and difficult to use in deep, narrow
wounds. Others have proved difficult to
remove from the wound once hemostasis
is achieved. An exothermic reaction
causing second-degree burns has also
been observed with some products. Furthermore,
the rate of stopping bleeding
and preventing re-bleeding has been
reported as inconsistent.
However, a new FDA approved hemostatic
product has recently entered the market,
having been thoroughly put to the test
during frontline military operations. Used as
a topical adjunctive agent to compression,
the granular product is easy to use. It is simply
poured into the wound prior to the normal
pressure therapy included in all first aid
training. Working in seconds, it forms a robust
clot that stops bleeding quickly.
The patented blend of materials forming
the granules includes chitosan, a derivative of shrimp shells, which has been widely
used in products such as diet aids, bandages,
shampoos and medical devices. The granules
work by bonding with specific sites present
on the surface of red blood cells and
platelets to form a strong gel-like clot.
This process is independent of the body’s
own clotting mechanism, which means it is
not affected by anticoagulants or cold temperatures.
It therefore works when the
body’s normal clotting system is impaired.
Laboratory tests on blood containing heparin
or warfarin (Coumadin) and blood that has
been cooled to simulate hypothermia have
confirmed this.
One of the major advantages of this new
hemostatic product is that it is simple and
safe to use, with no specialist training required.
The packet is easy to open and can
be self-applied in extreme circumstances if
assistance is not available. Its granular form
allows it to be applied to deep narrow
wounds or spread over open surface
wounds. It is also safe for use with chest,
head and neck wounds.
Be Prepared
OSHA Regulation 1910.151.b requires
“adequate first aid supplies shall be readily
available” in every workplace. Various elements
should be considered when assessing
the requirements for each particular working
environment. The nature, size and distribution
of the workforce are key factors.
It is important to consider the remoteness
of work sites and employees travelling or
working alone. Health and safety personnel
should consult with local EMS to find out
realistic response and transport times in the
event of an accident and equip employees
with the tools and training to manage situations
effectively while waiting for them to
arrive.
Hemostatic agents would help any first
responder to rapidly stabilize a wounded
person’s condition and increase their
chance of survival, particularly when emergency
services are delayed. The success of
this new hemostatic technology on the battlefield
should prompt employers to consider
these products as a vital addition to
their first aid boxes, enabling first responders
in every workplace, particularly those
in high risk industries, to rapidly control
bleeding.
