Building In-House Capability

It's time to look in the mirror and take stock. By just providing what the laws and regulations require, we are by default deciding we will do the least we can do.

"Our employees are our most valuable asset." How many times have you heard or read that statement? When it appears in the context of EHS or Safety programs in general, it usually is a prelude to an explanation about "the new program" and how it will help protect or ensure the safety of those valuable assets. The managers issuing the statement think, "Here is what we are doing for them," and the employees are hearing "blah, blah, blah" and wondering when they can get back to work.

It is part of the understanding between employer and employee that has gone unspoken since the Industrial Revolution began. The Employer needs to comply with certain regulations and requirements, and the Employee needs to comply with the work rules. Many times, each in his own way really cares about doing it right, but most times he is just trying to "get by" and make everybody (the regulators) happy.

[Please note: This is part one of a two-part article. The second part will be published in the February 2011 issue of OH&S and posted on ohsonline.com beginning Feb. 1. Editor.]

In the case of emergency medical care in the workplace, this scenario usually takes the form of the employer providing first aid kits, possibly an AED, and bringing in a first aid instructor from some local agency and paying a few employees for the time they spend in the class. The Employer has satisfied the "requirement," and the employee goes back into the workplace with one of three possible mindsets: 1) "Well, I am now ready for anything that can happen (unless there is a lot of blood)"; 2) "Gee, if somebody really gets hurt, I sure hope I'm out that day because I don't know if I can do this stuff"; or 3) "Well, that was an easy eight hours. Nobody gets hurt here, and it's a good thing because I really didn't get much out of this class besides the nap."

If you are reading this and nodding your head, then obviously you "get it." If you disagree, then ask yourself these questions: Does our first aid/CPR training take into account the hazards we have in our facility? Are our "first aiders" trained to mitigate a hazard to an employee and keep him alive until professional responders arrive? If you answered yes to both questions, then try this: Do you know for a fact how long it will take for an Advanced Life Support (ALS) ambulance to arrive on scene? If your answer is six minutes or more, then you have some work to do. In six minutes, brain death begins to occur in the cardiac arrest patient, and the chance of successful resuscitation starts to fall precipitously.

Right now, take a look at your closest co-worker at the desk or machine next to you and decide whether you're willing to watch him or her die because you didn't want to put the effort into a real response system for your company. Harsh words? Yes, truly they are, and they may even appear to be alarmist. However, the truth is, by just providing what the laws and regulations require, we are by default deciding we will do the least we can do. Too often, the results in patient outcomes that are not what everyone would like to see.

If you came through all of those questions, here is a final one: If I dropped right here at my workstation from an undetected condition, do I trust my co-workers to take care of me and keep me alive until a paramedic gets here?

The Process of Change
In the EHS field, we are quite familiar with the cost of safety or a lack thereof. We know the extended cost of an accident far exceeds the cost of the initial medical care. What we don't often consider is the cost on productivity. It is known, but we don't talk about it much and therefore don't understand it as well as we should.

If you've had a bad accident at your workplace, then you know that pretty much everybody stops working. They want to know who got hurt, how they got hurt, why they got hurt, who is taking care of them, are they going to the hospital, and the biggest question: Are they going to be "OK"? If it turns out the injury was severe and the person does not return to work the following day, the questions and conversations continue. If it turns out that the incident became a fatality, there is further time lost in all of the planning and support required for the family and co-workers.

Of course all employers are sensitive to the needs of their employees during times of serious distress caused by the loss of a co-worker, and they would be foolish indeed to ignore them. Nonetheless, one has to ask, as callous as it may seem, whether anything can be done to minimize these hidden costs. The truth is that proper planning and training not only can provide better care for a group of employees, but also can put their minds at ease that everything that could have been done for a co-worker was in fact done and done well. This provides confidence and peace of mind that the company is doing the right thing by making sure it is prepared to handle whatever may come up. There is no second guessing or finger pointing and minimal discussion of lawsuits, we hope. It sounds good, right -- but you are probably thinking this is going to be tough. It won't be easy, but you can break the task into manageable stages because each one will probably take some period of time to accomplish or institute.

Step 1: Change the culture.
The average EHS Manager right now would be thinking, "This all sounds good, but we really need to consider how much care and training we want to provide because we might get sued." This is where most companies drop the ball; they fool themselves into thinking they might wind up in court because they tried too hard.

The facts are just the opposite. Any employee who is trained in first aid, CPR, or any other level of medical care is considered a Good Samaritan under the law and is held harmless under the law, provided they do not administer care in which they are not trained. There is no available evidence of a successful lawsuit against a Good Samaritan who stayed within his or her training guidelines. On the other hand there are many cases of successful lawsuits against employers for not having the proper care available in situations where the possible hazards were known to the employer.

So let's agree right here that we have debunked the issue of "trying to do too much." If you are in a more substantial corporation, there are probably some legal eagles available whose job it is to protect the company and its employees from legal actions. If you ask them about putting in a more aggressive plan, just make sure you ask them the right questions. If you ask about liability with a more aggressive plan, they will probably take the easy way out and advise that you keep things as they are. But if you ask about the case history on companies getting sued for providing an insufficient or inadequate response, you should get some very different answers. If your lawyers still say "no go," challenge them to back up their opinion. In the end you will change the flow in your favor; just be persistent.

Step 2: Get some education.
So now you are thinking, "OK, so we won't get sued, but how do I make this happen?"

In fact, it's not easy. (Surprised? You shouldn't be.) Our system is set up to let everyone "get by." If you really want to make a difference and raise your response to a workable level, you have to do some work. First, realize that most EHS folks don’t have medical response training. Think about this: The overwhelming majority of first aid and emergency medical programs are created and overseen by people who have no medical training beyond basic first aid (sometimes not even that).

Would your company have your Engineering Department managed by someone who had taken a drafting course in high school? Why then are we having minimally or even untrained people setting up our medical response programs? If you are The Safety Dude at your company, you need to fill in this gap and get some training. Don't take the easy eight-hour first aid class that is available locally; chances are it is designed just to meet the minimal regulations. (Avoid the classes that are designed for teachers and coaches to meet their minimum requirements because you'll be right back in the same rut. You need a class designed for people who expect to use these skills.)

As a professional, you need to understand this stuff so that you can make good decisions. Do a little research and find a Certified First Responder (CFR) Course. Yes, it's going to take about 50 hours out of your life, but you will hold the skills for a long time even if you don't recertify when it expires. In the meantime, you will have gained an understanding of the human condition and how to deal with it. You will not regret the experience, regardless. If you really want to go all out, find an Emergency Medical Technician (EMT) class and take that. Depending on your state, these run around 150 hours and can include ride time on an ambulance as well as clinical time in an emergency room. Now you are getting an idea of what your co-workers will be going through when your company calls 911. (Of course, joining your local fire department or rescue squad would make you a very valuable asset to your co-workers and teach you a whole lot of useful skills, but that is up to you.)

One other option is to find someone in your company who is already trained at these advanced levels. Look for firefighters, rescue squad personnel, or others who may have done that sort of work in the past. These folks can be a huge help to you and can provide information on how things work "out in the world" and what your local protocols and regulations might be. These folks can also become your internal responders as well as future in-house instructors and coaches. If you are lucky and have these people in your organization, remember to be kind to them. They have put a lot of time and effort into their certifications, as well as the ongoing time they put in to keep theirs skills up. They do this on their own time.

If you lean on them for support, you might try to find a way to show your appreciation. Giving them a little paid time off to take classes, recertify, or attend an EMS convention would go a long way toward keeping their support. All of these things would benefit your organization anyway, and they will feel they are appreciated.

Step 3: Evaluate your program.
Once you have some training and understand what can be easily provided to your co-workers, then you need to evaluate your current program. A team format with two to four members can work well here.

Does your current program match the hazards present in your facility? Do you have special considerations that require special precautions, equipment, or training? When you took your class, you will have met and worked with the people who can help you work through these specific issues. If not, call your local emergency service agencies and tell them what your challenges are; they most likely will be very eager to help close the gaps and help you out.

Keep in mind that the more your facility knows and is prepared for, the easier the professional responders' job becomes. They are always anxious to build relationships that allow them to do their job more quickly and effectively. That's their mission. They will be more helpful than you might guess. Evaluation is a key component to ensuring you have reviewed the hazards and considered how to deal with them. Keep documentation records of your evaluation. In the event of a serious event requiring an investigation, this documentation will show that you looked at all the reasonably foreseeable hazards and included them in your working program.

This article originally appeared in the January 2011 issue of Occupational Health & Safety.

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