Episode 9: First Aid In The Office

Introduction to First Aid Unboxed Episode 9

Mark: Hello, and welcome to episode nine of First Aid Unboxed, the podcast that demystifies everyday first aid for all of us out there. And my name's Mark Wakeley, I'm purely the facilitator of this. The real expert is Louise Madeley from Madeley's First Aid Plus, who's been working in medicine for around 30 years now.
Mark: What are we gonna be talking about this week?
Louise: We mentioned it at the end of last week, we're gonna talk about first aid provision and in the sense of first aid boxes, bags, that sort of thing.

First Aid in Work and Leisure Environments

Mark: Okay, and this is in a work scenario, so in offices basically?
Louise: Yeah, although it can translate into leisure as well. Certainly, things that you need or you may need in construction, for example, would be quite handy if you were going up Ben Nevis, that sort of thing.

Health and Safety Regulations for First Aid

Mark: And are there rules and regulations? Are there health and safety regulations which offices have to follow?
Louise: Yeah, so we've got the Health and Safety Executive, which most people are aware of if they've got their own business or work in business, and we work to the health and safety regulations. For first aid provision, though, we are talking about the Health and Safety First Aid Regulations 1981.
Mark: Okay, and what does that say?
Louise: It's to determine what sort of first aid kit you need, for example, what facilities you require, whether you need an eye bath station, for example, if you're working with chemicals, whether you need just a basic first aid kit, be it a box or a bag or whatever, and how many people you need, depending on how many employees and what equipment you've got that may hurt people.

First Aiders to Staff Ratio

Mark: So what are the numbers as far as first aiders to members of staff?
Louise: Fairly black and white in that, if you read the HSE website, it's very much about 0 to 5. Technically, you don't need a first aider, so somebody who has done the Emergency First Aid at Work or the First Aid at Work three-day or one-day course. However, when you get to five, it's 5 to 50.
Mark: So if you have five employees, up to 50 employees, then you also need a first aider. But you have to take other things into account. So for example, if you're working on a farm and you've got heavy plant machinery, you really need somebody to be able to know what to do.
Louise: Tourniquets, for example, if they work on tractors, particularly on hills, Welsh hill farmers, for example, certainly should be carrying tourniquets and other things for catastrophic bleed and the nasty things that can happen courtesy of heavy plant machinery. And they should be trained to use that stuff. So it's not just about numbers, how many people.
Mark: If you've got equipment that can hurt somebody, you should have somebody there trained to know what to do with the injuries that could happen courtesy of that piece of equipment.

First Aid in Agriculture

Louise: I was at a presentation yesterday, a health and safety presentation. And apparently, farming is the most dangerous on-land industry in the country.
Mark: Well, as you know, I started out my life in farming. And I was a farm manager at a very young age, about 19, when I first had a management job in farming. And yeah, absolutely, it was then.
Louise: It's also the industry that has the most suicides, and that hasn't changed. None of this has changed in 35 years. It's still the biggest major accidents, shall we say, that hasn't changed in 35 years.
Mark: And in areas that have the least access to first aid provision?
Louise: Absolutely, yeah. You know me really well, Mark. You know my farming background, and my husband's farming background as well. He's a land agent, so works primarily with farmers and landowners. And I'm very much about promoting that in some way, don't ignore what the regs say, but what the regs say may not be enough. You really need to have everybody that works on a farm with that kind of equipment, knowing what to do, and loan workers as well, having loan worker risk assessments.
Mark: So somebody who is up a hill, for example, on a tractor, those tractors can roll. Happened to my grandfather, actually. He was going back to the '60s, earlier than that, actually, '50s. And my uncle was only about 6. He was on the side-by-side tractors, no roll bar, nothing, perfectly legal at the time, but obviously a death trap. Rolled the tractor with my 6-year-old uncle on it.
Louise: And at the time, they didn't know whether or not my uncle was going to survive. He's fine. They've had other kids since, you know, there's all is well, but that didn't necessarily, it may not have ended that way.
Mark: And that was very common then. However, we do have lots of regulations in place for the agricultural sector. Whether that's being abided by all the time is another story.
Louise: Certainly from my experience, there are still a lot of farmers and we have it, especially in Shropshire. I got quite a culture shock when I moved from London to Shropshire, certainly from an A&E and ITU point of view, where people really do turn up on the back of a Land Rover with things hanging off and no first aid en route, for example, and no idea how to do first aid en route. And that didn't necessarily have to be the case. You know, they could have come in in much better condition and preferably via an ambulance or air ambulance would have been good.

Agricultural First Aid Courses

Mark: At Madeley's First Aid Plus, do you do specific agricultural first aid courses?
Louise: Yes. Yeah, I do something called the Forestry and Farming First Aid. It started off as the Forestry First Aid, which if you're involved in the Forestry Commission, they do insist that people have the Forestry First Aid training.
Mark: That is basically the Emergency First Aid at Work course, which is a one-day with a bolt-on, which relates to hemostatic dressings, applying tourniquets. I've got fairly gruesome stuff. You've seen it before.
Louise: All sorts of catastrophic wounds, scenarios, and simulations. And we use the different hemostatic dressings to pack the wound and use tourniquets and so on. So I teach people how to do it, not just to another person, but on themselves.
Mark: Tourniquets can be used by the person themselves. That's the great thing about them. If you are on your own and you have no choice, you are bleeding out of a limb, there is a way of doing something on your own with nobody else there. Because many farmers obviously are working on their own. They are the only one in the field doing a particular job. So they need to be able to do first aid on themselves as much as anyone else on the farm.
Louise: Yeah, there is only so many hazards that you can mitigate against. Things do happen. No matter how much you mitigate against hazards and accidents happening, they can still, you know, they do happen, unfortunately.
Mark: It's just about knowing what to do if something does happen.

First Aid Kits in the Office

Mark: Okay, so in the office, should every office have a first aid kit?
Louise: Yes.
Mark: So a first aid box, basically, or bag?
Louise: Yes.
Mark: Depending which?
Louise: If it's an office, all you need is a basic first aid kit, basically. One thing I would say is when you do buy your kit, and we all do it, you buy the kit, it's got everything inside it that you need. You've gone through and checked the contents, etc. If somebody comes in to check that you are compliant with your first aid kits, and that's whether it's for catastrophic bleed, whether it's outdoor environment, or your basic bog-standard first aid kit, people forget that when they've bought it, that's not the end of it, and you just change things as you use them, which we all do. You use a couple of plasters, you put a couple of plasters back. It's a lot more than that.

Maintaining First Aid Kits

Louise: So for example, your first aid manual, your guidance leaflet, for example, that needs to be changed regularly. So what I do in our office, because yes, I've got all my fancy first aid kits, etc., but we're still in office, and separately, we have our first aid box, which somebody else, another first aider is responsible for. So what she does is every three months, she's got it in her diary on Outlook to make sure that she checks it over to see expiry dates. Once a year, she puts it in her diary as well to make sure that she changes that guidance leaflet. And that can mean just going on to the HSE website, for example, and downloading it for free. It's the updated guidance. We do it once a year. Just stick it in your diary to remind yourself.
Mark: Once a year, download it off the website and print it out, stick it in your first aid box.
Louise: And what other things would you find in an office first aid box?

Contents of an Office First Aid Kit

Louise: So guidance leaflet, very important. Make sure it gets changed, like I just said. Now, things have changed. We used to have things like crepe bandages, for example, and then you would get your size 10 by 10 wound dressing, which is like a square dressing that you put on, and then you wrapped the bandage around it. Those days have gone. Things go wrong with those. They get put the wrong way round, all sorts of things. So that was stopped. What they now have are non-adhesive dressings, so really important. They're not bandages like we're used to. You've got crepe bandages, and then you used to have the 10 by 10 dressings that you would apply, and then put the bandage over the top. That's now stopped, which is why you will now find that all these dressings, and it'll say dressing on it, either wound dressing, ambulance dressing, something like that, they all have expiry dates on them. Reason being because within that non-adherent layer, so to speak, it has a leno-weave fabric within it, and it's imbedded, usually impregnated, with soft paraffin, like Gelinette or something like that, something that's going to stop it from sticking against the wound, which is what you want. Because of that, these things are likely to degrade, hence you get expiry dates. So it is really important, and I get it all the time, why have an expiry date on a bandage?
Mark: Well, because it's not. It's as simple as that. They're not bandages.
Louise: As soon as you pull them out, you will see that non-adherent layer, the wound dressing, in other words, and that's what you put on to the straight on to the skin. Shiny side down. That's the side that doesn't stick. It's a bit like when you put cling film on, take cling film straight off anything. Cling film is wonderful with burns, with wounds. The way it works when it's in the factory, it's sterile on the inside. So the minute you pull it off, you can put it straight on to the wound, and it will become airtight immediately. So cling film is very good, particularly for burns. You don't necessarily need that in a first aid kit, though, a basic first aid kit, unless you want some in the kitchen, if you've got a kitchen in your office, or somewhere where you have risk of scalding, et cetera. Then cling film's good. But generally, you will find these wound dressings, several of them, medium and large, are usually what you have. You may have gauze pads in there.
Mark: I don't tend to use gauze pads, particularly. I don't find them particularly effective, and they can risk sticking. Adhesive tape, wipes.
Louise: The thing to remember with wipes, always alcohol-free, for starters, it is extremely painful if you have an alcohol wipe and you put it on to somebody's wound. Really hurts, and it's unnecessary. When you use one, though, you've got to remember that everybody's skin has got flora on it, so it's got lots of bacteria there. And while it's on your skin, it's great stuff. It's supposed to be there. It's protective for your skin. However, if you then wipe it, and it wipes into a wound, it's not where it's supposed to be. Hence, you get an infection. So be very careful with a wipe. Wipe once, throw it away. Get a second one. Wipe once, throw it away.
Louise: It's not really in first aid about making it all nice and clean and beautiful. You're not doing anything sterile here. All you're trying to do is stop the bleed until they can get to the hospital. So if, for example, a wound is soiled, it might be that a child has gone over, abrasion on their arm, and they've skidded through dog poo, for example, in which case you need to wash that off. A little wipe is not going to do that. You need to wash it off and then put a dressing on. It's not that you're doing sterile dressings, aseptic dressings, I should say, whereby there's absolutely no risk of infection getting in. It's really just about making it safe, stop the bleeding, get them to A&E to be treated properly, and everything will be done aseptically there. And if necessary, they'll be given antibiotics to cover them.
Mark: So what's next in the box?
Louise: iPads, always great. Should always have two for the simple reason that if somebody gets something in their eye and you cover one eye, but you need the eyes to stay still, the other eye is still moving and they're conjoined. So you need to cover both eyes if that happens, to stop them from moving around and seeing things and looking about. The only thing you can do is pop two on, obviously keep them nice and safe because they cannot see anymore. So look after them, get them to A&E. If it's a case that you are covering both of their eyes for any reason, they're going to A&E, end of.
Louise: So get them to A&E if necessary, call an ambulance. But always two iPads. Eye wash, generally, we tend to say, yes, you get sterile saline, and that's okay. But I've never really met one that gets anything out of eyes. We do recommend that if something is in the eye, chemical burn, for example, splashed into the eye, the affected eye under the water for 20 minutes, if they can tolerate it. You need to wash that eye out quickly and as well as you possibly can. A little bit of irrigation in a 10 ml pod is not going to do the job. You need 20 minutes under the tap. And regulations now, they're all saying the same. 20 minutes for a burn, 20 minutes to wash eyes out, etc. Keep it nice and simple. So eye dressings, really, iPads are there to pop on after you've washed anything out, if it's safe and okay to do it.
Mark: Obviously, if something is embedded in the eye, that is very different. Disposable gloves, either nitrile or latex, tend to stay away from latex these days, just because of the number of allergies. It can have both, but why?
Louise: You might as well have nitrile that everybody can use. So really, they are to protect both the rescuer and the injured person. And it's just about keeping body fluids away from you, is what it's about, as much as anything, and keeping whatever's on your hands away from that person.
Mark: So it's about keeping yourself safe. Definitely, you need some scissors. There's a lot of questions over tweezers. Some say yes, some say no. It shouldn't be the metal tweezers anyway. It should be the blue plastic ones or something similar, sustainably similar. There's splinters, a tick remover, if you're in an area where you get lots of ticks. Anything to get debris from wounds out. That's the main reason you would use tweezers. But generally, it's not about removing debris anyway. It's about washing out if necessary and getting them to A&E.
Louise: Triangular bandages is the next thing which I'm not always a fan of triangular bandages. And certainly when you come out of A&E, we use something called a collar and cuff. So it's a piece of blue foam that goes around the arm and via the neck and just holds it in place. Really, that's the only thing you need to do with a triangular bandage.
Mark: So basically, these are the provisions that you need under the rules and regulations of the health and safety provision? Okay. And as I said, all these are available from Madeley's First Aid Plus.

Future First Aid Topics

Louise: If people need more information, where would they need to go to?
Mark: Madeley's First Aid Plus, www.madeleysfirstaidplus.co.uk. The landline is 01952 727 007, or enquiries@madeleysfirstaidplus.co.uk.
Louise: And any questions that arise from any of the podcasts that we've done in the past, or today's podcast, can all be answered by Louise, if you contact them through those methods. We're going to have a look at other in-work first aid provisions in future episodes. So what are we going to be talking about next time?
Mark: Well, so far we've only talked about the basic first aid kit that you need in an office, a low-risk environment. There are lots of environments that people work in. We've discussed very briefly about farming, but construction, manufacturing, things where you have heavy plant machinery, where you have equipment that can cause a lot more damage. Obviously, you need to mitigate the hazards, but at the same time, you need to look at all the first aid kit that you need, should anything happen.
Louise: Okay, so next week, we're going to be starting on those subjects as well, looking at higher-risk environments, not just office environments.
Mark: Thank you very much, Louise. It's been enlightening as ever.
Louise: My pleasure.
Mark: And we will be back in two weeks' time with another episode of First Aid Unboxed. So thank you very much for listening. If you've enjoyed what you've listened to, you found it informative, please tell your friends and colleagues about us. Also, click the subscribe or follow button, depending on which platform you're listening on. And we'd really love it if you could review it as well. It really helps with the algorithms if you can review the podcast. So thank you very much, Louise. We will speak to you all in two weeks' time.
Louise: Thank you. Take care.

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