Episode 10: First Aid In A Dangerous Environment

Introduction episode 10 of First Aid Unboxed

Mark: Hi, and welcome to episode 10 of First Aid Unboxed. This is the podcast that helps demystify everyday first aid for you. Of course, I'm just here as a facilitator.
Mark: My name's Mark Wakeley, but our expert is sitting across the way from me here, and that is Louise Madeley from Madeley's First Aid Plus. Good afternoon, Louise.
Louise: Good afternoon.

Episode Overview

Mark: So we're up to episode 10. What are we going to be talking about this week?
Louise: Last week, we were talking about standard first aid boxes and what to expect in those. This time, we're talking more about the legal requirements, the standards that you need to reach, how risk assessments come into all that, and looking at a more specialist type of kit. So this time, we're talking about the more hazardous environments.
Mark: So what you need in the office, but then above that, for example, going into factories or, again, it all depends on your risk assessments.
Louise: So the different work environments need different provisions?
Mark: Absolutely.

Legal Obligations for Employers

Mark: Depending on what the risks are there. Yeah. Okay, let's look at the legal obligations then. There are laws that cover this sort of thing, aren't there?
Louise: Yes. Tell me about the legal obligations that an employer has.
Mark: Well, the most important one, the legal requirements and standards, is down to the Health and Safety First Aid Regulations 1981. So that's what everybody works to. That's the mandate.
Louise: That employers provide adequate and appropriate first aid equipment, make sure the facilities are correct, and that they've got the right personnel in the right post. So everything is determined, as far as first aid is concerned, on the Health and Safety First Aid Regulations.

Understanding Legal Requirements

Mark: How would you know what your legal obligations are in a particular working environment?
Louise: Two ways. One is, if you do have a health and safety consultant within the business, or if you outsource to health and safety, they'll be able to direct you. The other is to go on to the HSE website, Health and Safety Executive website. On there, you will find all the information that you need from basic risk assessments, that you can do templates, etc. right through to specialist equipment that you might need, depending on the risk assessments.

Conducting Risk Assessments

Mark: And let's talk risk assessments. Have you had to carry these out, or is this something that the office manager or the first aid has to do?
Louise: Yeah, so anybody can do a risk assessment at the end of the day. I generally suggest within a business that it's somebody who is taught how to do risk assessments, to be honest. Either a health and safety or somebody like me, I go in and do risk assessments for first aid. I'm not health and safety, I'm first aid. So I don't do health and safety risk assessments, but I do do those for purely for first aid. Employers have got to conduct risk assessments for first aid needs.
Mark: They determine what resources you're going to need as an employer for your employees. So it can be based on the nature of work, hazards associated with the workplace, the size of the workforce, distribution across the site. So how many people you have in certain buildings, if you've got multiple buildings, and what equipment is within those buildings.
Louise: The location, size, and remoteness of the workplace. So do you have loan workers, for example? You need separate risk assessments for loan workers who, I mean, my husband's got this in his business, where he and some of his staff will be working off site. They go into farms and other businesses to work, so they need a loan worker risk assessment. And they must consider workforce history of accidents and illnesses. If there are specific hazards in certain environments that have had accidents previously, for example, it's mitigating risk. That's the key. First, you want to mitigate the risk using your risk assessment, make the risk as low as you can possibly make it, and then if something still happens, that you make sure that you've got the right equipment to be able to deal with that.

Selecting the Right First Aid Equipment

Mark: Let's move on to the equipment. We've talked about first aid kits before, but obviously, what you have in a metal pressing factory is very different from what you have in a veterinary surgery, for example. So this is part of the risk assessment, I assume.
Louise: It is, absolutely. You've got the correct equipment for the environment.
Mark: Yeah, absolutely. There are millions of kits out there. It's about making sure that you have the right kit and the right equipment within that kit for the environment that you're in. Like you said, veterinary surgery is going to be extremely different with the hazards that they've got compared to a factory. So it's about making sure that those risk assessments are accurate for starters. They're updated regularly, minimum of yearly, and that what that risk assessment says is what you are doing. Because there's no point that you can have the best risk assessment in the world. But if you don't actually apply it, it's absolutely pointless.
Louise: So we're looking at the example, like I said before, of a metal pressing plant. What kind of extra things would they have to have in their first aid kit that you wouldn't necessarily need in a normal office kit?
Mark: So in a basic first aid kit, we went through this last week, things like the guidance leaflet, the plasters, iPads, triangular bandages, safety pins, sterile wound dressings, all of these need to be in the kit as well. But it's about the additional supplies for high-risk environments. So it could be that I would suggest all first aid kits have a resuscitation face shield, for example, where you place it over the face prior to mouth to mouth. But it may be that you need foil blankets. So a way of keeping that person warm, particularly if they're at risk of going into shock. So if you have equipment that could cause somebody to bleed heavily, as an example, then you need foil blankets because they could go into hypovolemic shock, which I mentioned on the other episodes, where they have a lack of volume, and that can make them particularly cold. They need foil blankets to keep them warm. Finger dressings, it could be, if you have high risk of finger injuries, if you have things like circular sores. Tourniquets, if God forbid, it is that it's very severe bleeding to one of the limbs, you may need to have tourniquets in there. Splints, if somebody works at heights, making sure that if they do fall, for example, could have broken or sprained limbs, that there are splints in order to immobilize. But it's not just about all of this. Hydrogel dressings as well for burns and scalds. It's really about people knowing how to use the kit. Because again, the kit is completely pointless if you don't have the personnel there, trained to use that kit.

Specialized First Aid Training

Mark: And with that, there are courses for various types of industries, I assume, for first aiders. It's not just a catch or first aid course.
Louise: No, absolutely. You can bespoke any training course, any first aid training course to the environment that the people on the training course come from. So for example, I did Catastrophic Bleed and Forestry First Aid course the other day to people, and they were from the forestry environment and tree surgeons, et cetera. So that covers severe hypovolemic shock, but also using tourniquets appropriately, using hemostatic dressings, and they actually have to pack a wound. So I've got simulators where I've got an extremely large amount of blood pouring out of a wound, and they have to pack it sufficiently, use the Israeli dressing, et cetera, before they can be classed as competent. They have to actually physically prove that they can stop a bleed in the event of, because just about everybody in that training room admitted that they have, not necessarily them, but they have witnessed a serious accident, a serious catastrophic bleed.
Mark: Every one of them actually had witnessed in one way or another something like that happening.
Louise: So these things are quite common in those kind of environments. I mean, we've talked to it before about farming being an incredibly dangerous way to earn a living.
Mark: Yeah.
Louise: And I see in forestry very similar again.
Mark: Absolutely. A few of them had had, if not seen a wound, a catastrophic wound. Things like the use of chainsaws when something has gone wrong, and they've had the right protective, the PPE, protective equipment on their bodies.
Louise: And they literally watched this chainsaw just saw into the leggings that the guy was wearing. Thankfully, because it was the right piece of kit, it's made of steel. So when the chainsaw comes down onto the leg, they're wearing safety trousers that actually chew, the chainsaw chews the trousers and chews the metal and forces it to stop. But it's actually on your leg when it happens. I mean, it's, you know, he did end up with bruising and a nasty leg wound. It wasn't catastrophic.
Mark: And that's because he was wearing the right kit. And again, that's going back to do your risk assessments, make sure that people are wearing appropriate PPE and that they've got the right guards in place, etc. It's mitigating risk again.

Legal Requirements for PPE

Louise: Is there legal requirements for PPE for jobs like that?
Mark: Absolutely. They must be wearing the right PPE before they can carry out the job.

First Aider and Staff Ratios Revisited

Mark: And when we're looking at first aid kits and first aiders, are there, again, parts of the law which say how many kits you need per number of personnel, how many first aiders you need for your personnel, and so on and so forth?
Louise: Yes, there is. So when you're doing the risk assessment, if it's down as a low hazard, so shops, offices, libraries, places like that, it's really down to the number of employees and the number and size of the first aid kits that you need. So if it's, say, one to 25 people, then you just need a small office-based first aid kit, a standard first aid kit. If it's between 25 and 100, they recommend a medium size and so on, over 100. One large one, and so on and so forth. You just multiply as to how many kits you need.
Mark: That's for a basic environment. When you're talking about high hazard, it could be light engineering, assembly work, trying to think food processing, warehousing, that sort of environment where there's dangerous machinery, then the number of employees, it comes right down as to how many kits you need. So, if it's 1 to 4, it's a small kit, 5 to 25 medium, 25 and above, then it's a large kit. But again, it depends on what environment you're coming from as to what's inside that kit. So, I always recommend a major-incident type kit where it's got all the tourniquets required. But it's how many of each item is required in that kit is based on how many people there are using the equipment.

Placement and Accessibility of First Aid Kits

Mark: And are there rules as well about placement of kits? So, if you've got a company that's over a number of different buildings, do they have to have kits and First Aiders per building?
Louise: Yes. The idea, in an ideal world, using your risk assessment, the number and size of your kits correspond with the risk assessment so that the First Aiders are able to get to the First Aid kit and reach a casualty within 60 seconds. That's the general rule. So, it's a question of you're at your workplace or something has happened and anybody can get to that kit, get back to that person within 60 seconds. That's the golden time, if you like.

Ensuring Quality and Compliance of First Aid Kits

Mark: Let's move on to what's actually in the kits. I assume there are, you've got to look at the quality of what's in there. And it's, you know, we heard loads of stories about inappropriate PPE during the COVID period. How can people make sure they're not buying stuff that is not the right stuff or good stuff?
Louise: So if it's a basic one, then you're talking about using something that has got the BS kit mark on it. So British Safety Standards, it is the 8599-1 compliant kits that you're looking for when it comes to employers and employee first aid. And making sure that if you are just in an office environment and it's a low hazard, low risk, you're using the standard first aid kit, which I mentioned before, conforming bandages, first aid guide leaflet, a contents list, sterile dressings, triangular bandages, iPads, et cetera. However, if it's a medium to high risk or hazard environment, then you're looking at a critical injury pack, which has all of the above but includes things like trauma dressings, hemostatic dressings, foil blankets, clothing, tourniquets, things that you're going to need for a high risk environment.
Mark: And you say these kits are available from many, many places and you can buy them online and from various suppliers. But you've got to look out for these British standards.
Louise: Yeah, absolutely, needs to be HSE compliant and it needs to have a British standard 8599-1-2019 workplace first aid kit, basically. If you see that on a first aid kit, then you're almost certainly going to have the right sort of kit.

Key Takeaways for Businesses

Mark: So what are the takeaways from this? Let's round this up. What's your bullet point advice for anybody in that business environment?
Louise: So first of all, check your health and safety requirements. Health and safety first aid regs, 1981. It states that employers are required by law to provide adequate and appropriate first aid equipment, facilities and personnel. So the equipment, in other words, if it's a high risk environment and there's likelihood of catastrophic bleed, then you must have a critical injury kit available for the right number of people. And as I said before, if there's one to four employees at risk, then it would be a small one and so on and so forth. It's also about making sure that you have the right facilities there. So do you have a sink that you can utilize if you need to wash somebody's eyes out, for example? Do you have a first aid workstation if that's required, which might have burns dressings in it, the standard first aid kit, critical injury kit within it, and an eye wash station, that sort of thing. So making sure that you've got the right kit, but also that you've got the right personnel there that are trained to use the kit, because none of this is any good. There's no point in risk assessments, policies, procedures, you can do all the flow charts you like, get the right kit in, British safety standard, none of it is any use if at the end of the day, the people don't know how to use it.
Mark: Of course, if they're in Shropshire, they should contact Madeley's First Aid Plus, and you run courses all the time for various things. If they're not in Shropshire, what do they need to Google if they're looking for the correct training for first aid?
Louise: It needs to be Emergency First Aid at Work minimum. So when you do your risk assessment, it will determine whether you need the First Aid at Work, which is the three-day full compliance course, whether you need the one-day Emergency First Aid at Work. Quite often you'll find in a high-risk environment, you will have X number of people that are First Aiders at Work, the three-day, and then you'll have more people that are Emergency First Aiders at Work.
Mark: And what certification do people need to look for?
Louise: Well, HSE state, somebody that's got a First Aid at Work qualification, they need to have a level three or above teaching and assessment course as well. That's actually all you need in order to teach first aid. So that's minimum requirement. Personally, coming from an A&E background and being medically qualified, my training is different, and I go into much more depth on how things work, etc. Hence, I'm here doing these podcasts. But it's also about checking that person out, making sure that they are the right person for the job as much as anything. It's very much, and you've got to remember, it's put onto the employer to make sure that that person is qualified and capable of giving you the right training. It's not up to the trainer. So make sure that that trainer is trained and capable of giving you the right qualification. Because if not, and something happens, then that person isn't First Aid at Work competent or Emergency First Aid at Work competent, in which case liability falls on the employer. So basically do your research.
Mark: Absolutely.

Preview of Next Episode: Diabetes and Hypo Kits

Mark: Okay. So we've got legal obligations, what you need to have in the office, your risk assessment, what the dangers are in the office. Looking at your first aid kit, make sure you've got the correct kit for the environment and you're working in. Make sure it's all British standard compliance, and make sure that any training you get, do a bit of research and make sure you get the right training from the right person.
Louise: Absolutely.
Mark: Let's quickly move on to something that we're going to be talking about next time, and something that I know is quite close to your heart, diabetes.
Louise: Yes.
Mark: Now, you gave me some very interesting statistics before we started the actual recording. So let's have a little chat about that, and then we can go into much more detail in the next episode.
Louise: Yeah. So I've been talking to a company who have diabetes hypo kits. So the Diabetes Safety Organization have come up with these amazing kits that, if I tell you these statistics, they really are shocking. So 700 people a day diagnosed with Type 2 diabetes in the UK. Currently, 4.6 million people with diabetes, of which 1 million do not know they've got the condition. So that's a million people walking around who could have a hypo at any moment, not even knowing that they are diabetic and that they could have that hypo.
Mark: So again, this is why it's important that people do do, this is the three day, because the one day Emergency First Aid at Work doesn't teach you anything on diabetes, or how to manage somebody who is having a hypo. It's the three day that does that, which is why I find it so important that people do do the three day as much as the one day. Although you can get away with doing the one day in a low-risk environment, you're still just as much risk of somebody having a hypo on you as you are in a high-risk environment.
Louise: So 5% have Type 1, 80% have Type 2. And actually the NHS spent 10 billion pounds a year on diabetes, 8 billion of which, that's 80% of it, are avoidable complications if people are given more education and support. On the impact of life, so impacting people's lives on a daily basis. Diabetes is the leading cause of blindness in the working population. And again, we're talking about employers here. The leading cause of blindness. 150 amputations a week from the condition. 75% of men who have diabetes will suffer from erectile dysfunction at some point. Again, all of this impacts on people's mental health. Estimated 12.3 million people at risk of Type 2 diabetes. Increased risk of Type 2 diabetes. So the problem is huge. On a site of 1000 people, 70 of which are likely to have diabetes, or will have diabetes statistically. It is a bit of a modern plague, isn't it, really? And it's avoidable.
Mark: It is. That's the thing. In most cases, not in every case, but in a lot of cases, yes, it is through good education and good support.
Louise: It is. That's why it's important to have diabetes hypo kits and proper training.
Mark: OK. We're going to go into great detail about this in the next episode. And we're going to talk about the diabetes hypo kit as well. Louise will go through what's in there and how you can get hold of one if you feel that you need one for your office or for whatever, for home or whatever it is.
Mark: Let's just quickly go through. Anybody who's got any questions or wants to know any more or even wants to know more about the courses, what's the best way to get in touch with you?
Louise: My website is www.madeleysfirstaidplus.co.uk. So you can use the contact form there.
Mark: And is that the word plus?
Louise: Yes, PLUS. Absolutely. Or you can contact me on my email, which is enquiries@madeleysfirstaidplus.co.uk.
Mark: So if you need any more information or want to talk about this, or have any comments to make about what we've been talking about on any of the episodes, or not just this one, then that's the best way to get in contact with us. If you've enjoyed the podcast, please tell your friends and colleagues about it. Follow us, subscribe to the podcast, please review these things all help to get the message out there. Lots of people are listening to the podcast all over the world as we've discovered. If you like the podcast, then please review it. As I said, it really helps with all the algorithms.
Closing Remarks
Mark: We'll be back in two weeks time, I think, probably, with the next one. And as I said, we're going to be talking specifically about diabetes.
Louise: See you in a couple of weeks time. Thank you very much.
Mark: Fantastic. Thank you, Louise. We'll see you in two weeks.
Louise: This is a 1386 audio production.
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Connect with Madeley's First Aid Plus
• Website: www.madeleysfirstaidplus.co.uk
• Email: enquiries@madeleysfirstaidplus.co.uk
• Phone: 01952 727 007
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Stay Tuned for Episode 11
Next week, we'll delve into first aid for diabetes, discussing the essentials of managing hypoglycemia in the workplace, the contents of diabetes hypo kits, and how to respond effectively to a hypo emergency.

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