Emergency Care Textbook Professional Responders-part-24.pdf

Workplace Introduction Some of the most serious injuries occur at workplaces because of the equipment involved and/or the nature of the work being performed. Emergencies happen in all kinds of workplace settings—industrial work sites, agricultural operations, construction sites, remote locations suc...

Workplace Introduction Some of the most serious injuries occur at workplaces because of the equipment involved and/or the nature of the work being performed. Emergencies happen in all kinds of workplace settings—industrial work sites, agricultural operations, construction sites, remote locations such as in forestry and mining industries, and even office environments. Most workplaces are required by law to have first aid attendants. When you are employed as a workplace first aid attendant, you have the duty to act. Regulations require you to provide care to the level of your training and to document all incidents appropriately. Your knowledge of what to do and your ability to react quickly can make a difference for an ill or injured employee. Applying your knowledge and expertise will help promote a safe and healthy workplace. Key Content Roles and Responsibilities of the Advanced First Aid Attendant............................. Responsibilities of the Employer and Other Employees............................ Return-to-Work Protocol.......................... Workplace First Aid Equipment............................ Workplace First Aid Transportation..................... Regulations and Documentation.................... Workplace Occupational Health and Safety Regulations....................... Workplace Hazardous Materials Information System............................... Documentation.................... Typical Workplace Injuries...... Workplace Emergencies......... 402 402 402 403 403 403 403 404 405 405 406 WORKPLACE 24 401 ROLES AND RESPONSIBILITIES OF THE ADVANCED FIRST AID ATTENDANT Workplace first aid is first aid performed in the workplace by a designated person: the advanced first aid attendant. The first aid attendant must be familiar with workplace occupational health and safety regulations in his or her jurisdiction, and must be an employee with a current, recognized first aid certificate from a recognized training agency. This certification must be for a level required by law for the particular workplace. The first aid attendant is an essential part of first aid services in the workplace under health and safety regulations. WORKPLACE The first aid attendant has the authority to send a worker for medical care if necessary. The patient is the responsibility of the attendant until care is transferred to qualified pre-hospital emergency medical personnel or hospital staff. 402 The advanced first aid attendant must: Have current certification at the required level. Maintain his or her knowledge and skills. Be prepared to respond both alone and as part of a first aid team. Provide all care in a professional manner. Provide care within the scope of his or her training. Thoroughly document any first aid-related actions and process paperwork according to legislative requirements (Figure 24–1). Report to the supervisor and joint health and safety committee as required. Conduct follow-up with the ill or injured person approximately three days after the person returns to work. Be familiar with specific elements of the particular work site, including: ◆ The  first aid room, rescue transport vehicles, and first aid equipment. ◆ Work  site entry and exit areas. ◆ Specific  hazards and precautions related to the work site. ◆ Legislative regulations. ◆ Means  of communication (e.g., radio system, satellite phone). ◆ Emergency phone numbers. Figure 24–1: First aid attendants must document all first aidrelated actions. RESPONSIBILITIES OF THE EMPLOYER AND OTHER EMPLOYEES Employers and employees are responsible for ensuring that care is provided in a timely manner in an emergency. Everyone on the work site should know how to access first aid assistance, including: Activating their workplace emergency response system. Calling EMS/9-1-1. Locating the first aid room. Summoning the first aid attendant. Locating first aid kits and other equipment (e.g., defibrillators). Return-to-Work Protocol Each person has the right to choose either to return to work immediately after an illness or injury or to seek further medical attention. This is a decision to be made by the ill or injured person based on recommendations by the first aid attendant. Supervisors cannot override the decision of the first aid attendant with respect to the treatment of an ill or injured person. Regardless of the severity of the incident, documentation must be thorough and in WORKPLACE FIRST AID EQUIPMENT Workplace first aid attendants will likely have access to most of the equipment described throughout this text, but exceptions may exist. Workplace first aid attendants may not be required to assess blood pressure or may not have access to certain commercial splints, for example. As a workplace first aid attendant, it is important to be familiar with the first aid equipment available at your workplace and to consider alternative means of applying your skills if commercial equipment is unavailable. For example, you might use a rolled blanket to improvise a head immobilization device. Workplace first aiders must know the specific first aid kits and equipment required for their worksites. Workplace first aiders should reference the CSA standard for first aid kits (CSA Z1220-17). workplace first aid attendant’s responsibility. Written procedures for the evacuation of injured workers must be developed for each worksite. Procedures for transporting injured workers must address a number of factors, including type of injury, location of incident and distance from medical care, and EMS response times. First aid attendants must be familiar with the procedures for transporting injured workers. Depending on their size, location, and industry, some workplaces may be required to have an emergency transport vehicle (ETV) to transport ill or injured people. An ETV is a dedicated vehicle that is available to respond rapidly during an emergency. ETVs must conform to many regulations: Many jurisdictions have specific requirements regarding vehicle characteristics, onboard equipment, and safe operation. Properly trained and licensed employees should be available to drive the ETV if the first aid attendant is providing care. Workplace occupational health and safety programs are required to include written policies and procedures regarding AEDs in the workplace. The workplace first aid attendant is required to be in compliance with all workplace AED policies and procedures, including all written procedures regarding AED access, AED training, and AED operation and maintenance. It is recommended that each ETV: Be capable of traversing the area it is intended to serve. Have headspace of at least 1 metre (3 feet). Provide protection from the elements (e.g., dust, sun, extreme temperatures). Allow effective communication between the driver and the first aid attendant, as well as between the vehicle and the hospital/medical advisor. Conform to any legislative requirements where it is operating. WORKPLACE FIRST AID TRANSPORTATION REGULATIONS AND DOCUMENTATION Workplace first aid attendants have the option of transporting an injured worker to medical aid by: Company vehicle Taxi Ambulance Workplace Occupational Health and Safety Regulations Preparing the patient for transport and ensuring optimal transportation to the hospital is the The Canadian Centre for Occupational Health and Safety (CCOHS) states that all Canadians have a fundamental right to a healthy and safe working environment.1 It explains that a health and safety program is a plan of action designed to prevent WORKPLACE accordance with legislative requirements. Across the country, different jurisdictions may have specific forms. First aid attendants must be familiar with legislative and employer requirements regarding documentation. 403 injuries and illness at work, and that it is required under Occupational Health & Safety (OH&S) legislation in most Canadian jurisdictions.2 Such programs outline the first aid requirements on a work site. Each province and territory in Canada interprets workplace health and safety regulations differently. In addition, there are regulations that apply to the federal government and other national organizations. Transport Canada’s 2016 Emergency Response Guidebook helps responders to quickly identify the hazardous materials in a transportation incident and protect themselves and the general public during the initial response phase of the incident. Employers are required to have a minimum number of first aid attendants on the work site at all times. The level of first aid training and the number of required first aid attendants are generally determined by the size and type of workplace. Workplace first aid attendants must be familiar with the legislation governing the jurisdiction in which they are employed. To better understand the regulations governing training levels and mandatory first aid equipment, contact or refer to the website of your legislative workers’ compensation body or visit the Canadian Red Cross website at redcross.ca. Workplace Hazardous Materials Information System The Workplace Hazardous Materials Information System (WHMIS) is Canada’s national hazard communication standard. The key elements of the system are cautionary labelling of hazardous materials, the provision of Safety Data Sheets (SDSs), and worker education and training programs. WORKPLACE HAZARDOUS MATERIALS IN THE WORKPLACE 404 A hazardous material is any chemical substance or material that can pose a threat to the health, safety, and property of an individual. If the presence of hazardous materials is suspected at the scene of an emergency, EMS should be contacted (if not already done by this point) and provided with the information. When approaching any scene, be aware of dangers involving toxic materials. Specialized training is required for dealing with situations involving toxic substances. When dealing with a hazardous material (haz-mat) situation, such as a chemical spill, responders will work within a structured system that provides guidance in managing the scene. At a minimum, responders should take awareness-level training dealing with haz-mat response. PREVENTION OF INJURIES DUE TO HAZARDOUS MATERIALS IN THE WORKPLACE About one-quarter of all workers are exposed to chemical hazards in their workplace. According to WHMIS regulations, employers must: Clearly label hazardous materials, including all toxic substances. Tell employees about risks and precautions. Have a detailed SDS available for every hazardous substance in the workplace. Give workers who may be exposed to hazardous materials the proper training in safety measures and emergency procedures (Figure 24–2). Employees should: Check all warning labels, tags, and posters in the workplace and follow the instructions carefully. Read labels and SDSs to find out the risks of each hazardous material, the safety measures Figure 24–3: In the workplace, injuries often involve the hands and arms. to prevent poisoning, and first aid for poisoning. Never use a product that is in an unidentified container. Note that many everyday substances can be hazardous in large enough quantities. Documentation It is important to document any actions taken when providing first aid for a workplace emergency. Whether an employee is returning to work or being referred for further medical attention, documentation must be completed. More than one type of form may be required. Regardless, proper documentation must include the following items: The name and occupation of the ill or injured person The names of any witnesses The date that the report was filed The date and time that the report was received, that the response was made, that care was provided, and (if applicable) that care was handed off to advanced medical personnel A description of how the illness or injury occurred If the patient’s care is transferred (e.g., if an EMR takes the patient to the hospital), this must be noted on the form as well. A copy of the patient assessment report should accompany the patient when he or she is transferred. TYPICAL WORKPLACE INJURIES Injuries in the workplace most often involve the hands and arms, which can get caught in machinery (Figure 24–3). The most common workplace injuries include: Soft tissue injuries (see Chapter 9): ◆ Abrasions ◆ Amputations ◆ Avulsions ◆ Burns ◆ Contusions WORKPLACE Figure 24–2: Workers who may be exposed to hazardous materials, such as chemicals, need training in safety measures. A description of the illness or injury A detailed description of the care provided A description of any problems or shortcomings at the scene that may have contributed to the injury or illness A description of the outcome (including details of how and when care was transferred, if applicable) The signature of both the first aid attendant and the ill or injured person (if possible) A description of the follow-up with the ill or injured person (approximately 3 days after the person’s return to work) 405 ◆ Impaled fish hooks ◆ Lacerations ◆ Punctures ◆ Subungual hematomas Various skin conditions, such as abscesses, dermatitis, and gangrene (see Chapter 9) Musculoskeletal injuries (see Chapter 10): ◆ Fractures ◆ Sprains ◆ Strains Head and/or spinal injuries (see Chapter 12): ◆ Concussions ◆ Eye injuries Poisoning (see Chapter 14): ◆ Animal bites WORKPLACE EMERGENCIES Because of the nature of the work performed, some of the most serious workplace injuries occur at industrial and agricultural sites. This section outlines some common hazards and unique concerns for these settings. Scene Assessment WORKPLACE As always, size up the scene of an emergency before entering. Do not enter if there is any risk to your safety. An agricultural storage area or similar storage facility should not be entered by a worker who is alone. Look for hazards such as toxic chemicals, fires or fire hazards, unstable structures, running machinery, or unsecured livestock/animals. If necessary, call specialized personnel such as the fire department, the Emergency Response Team (ERT), or a hazardous-materials (haz-mat) removal team to stabilize the scene before you enter (Figure 24–4). 406 Be sure to observe lock-out/tag-out procedures. These safeguard against the unexpected startup of machinery and equipment, or the possible release of hazardous energy, when machinery is being maintained. The individual using the machinery turns it off and disconnects it from its energy source before performing maintenance, and an authorized employee either locks or tags the energy-isolating device to prevent the unwanted release of energy. Figure 24–4: Call specialized personnel, such as a haz-mat removal team, to safely remove toxic chemicals. Machinery that is turned on and/or that might be leaking fuel or hydraulic fluid should not be approached. CONFINED SPACES Confined spaces pose specific safety concerns (see page 34). It is important that responders who are required to enter a confined space follow specific guidelines. Never attempt an emergency rescue involving entry into a confined space without training in safe confined-space entry and rescue procedures. Assume that a confined space is hazardous. A person qualified to enter a confined space must ensure that structures are safe from collapse prior to anyone entering the confined space. A first aid attendant must be present directly outside the space to provide help to the responder inside, and there must be a plan for emergency rescue. There must be a safe method of communication between the responder inside the space and the first aid attendant. Appropriate PPE must be worn by the responder entering the confined space. Exact equipment is determined by the specific hazards encountered in the confined space but may include eye/face, head, and foot protection, respiratory protection, safety belts, lifelines, and harnesses. Confined spaces should be clearly identified, warning signs should be posted, and, when possible, the entry should be physically blocked. The conditions must be tested prior to the Adequate air conditions must be maintained in the confined space through proper ventilation. If safe atmospheric conditions cannot be maintained, the absolute necessity of entering should be evaluated. If it is necessary to enter, an appropriate respirator must be worn. Properly trained workers must control utilities prior to entry into confined spaces, including, for example, electrical services, gas, propane, water, sanitary systems, communications, and any secondary service systems. If an unsafe situation develops, the space should be exited immediately. ROADSIDE CONSTRUCTION Roadside construction sites pose many hazards for workers, mainly due to passing vehicles. Use traffic control personnel (TCP) where signs, traffic control devices, and other procedures cannot provide effective traffic control, or when emergency or rapid work makes these impractical. Assess the level of risk faced by the TCP in each situation. Consider traffic speed, direction, and volume, as well as weather conditions and the time of day. Plan and assess escape routes based on the traffic control layout but also on the time that is required to safely move out of the way if a vehicle does not stop as directed. Ensure that TCP stand in a safe position, are clearly visible, and have an unobstructed view of approaching traffic. A safe position is usually on the side of the shoulder of the road, out of the way of moving vehicles. Ensure that TCP are trained to the required standard and have current qualifications. REMOTE LOCATIONS Working in remote locations (e.g., in mining or forestry) exposes workers to a variety of hazards. This workplace may include large areas of terrain whose conditions may vary from mountainous to swampy. Safety concerns encompass a wide range of considerations. While working in remote locations, workers need to consider several risk factors, including: Rising water or flooding at times of high runoff. Vulnerability to forest fires. Avalanches, falling rocks, or slide dangers. Unsafe drinking water. Animal habits (e.g., risks of a bear encounter may be increased near old garbage dumps or camps, bear trails, spawning creeks, or berry patches). Camp size (i.e., whether the area is sufficient to carry out operations safely). Environmental factors, such as extreme temperatures. Tall or dead trees, especially dead branches that could fall into a campsite with strong winds or lightning strikes. Remote locations also pose risks due to their sheer remoteness: In some cases, emergency transportation may be delayed due to weather or other factors. Workplace first aid attendants need to be prepared to provide care until the ill or injured person is handed over to personnel with more advanced qualifications (i.e., the hospital or EMS). HAZARDOUS MATERIALS INCIDENTS When approaching any scene, you should be aware of dangers involving chemicals. Whether a motor vehicle collision or an industrial emergency is involved, you should be able to recognize clues that indicate the presence of hazardous materials, including: Signs (placards) on vehicles or storage facilities identifying the presence of hazardous materials. Spilled liquids or solids. Unusual odours. Clouds of vapour. Leaking containers. Placards, or signs, are required by law to be placed on any vehicles that contain specific quantities of hazardous materials (Figure 24–5). In addition, WORKPLACE responder entering and continuously monitored during entry. Testing must be performed by someone who is properly trained and has the appropriate equipment. Do not rely on your senses to determine whether the air in a confined space is safe. Many toxic gases and vapours are invisible and odourless, and a low-oxygen environment will not be visually obvious. 407 spark that sets off an explosion. When you call for help at a scene with a suspected hazardous material, use a telephone or radio that is located a safe distance away from the scene. 1202 3 Figure 24–5: A hazardous material placard. manufacturers and others associated with the production and distribution of these materials are required by law to display the appropriate placard. Placards can clearly identify the danger of a substance with universally recognized symbols. Terms such as explosive, flammable, corrosive, and radioactive are frequently used. WORKPLACE Unless you have been specially trained and possess the necessary equipment, clothing, and PPE for handling hazardous materials without danger, you should stay well away from the area. Stay out of low areas where vapours and liquids may collect. Position yourself upwind and uphill from a hazardous area. Remain alert for wind changes that could cause vapours to blow towards you. It is not uncommon for responding paramedics approaching the scene to recognize a hazardousmaterials placard and immediately move to a safe area before summoning more advanced assistance. Do not attempt to enter a scene for which you are not trained or prepared. 408 Many fire departments have specially trained teams to handle incidents involving hazardous materials. While awaiting assistance, keep people away from the danger zone. Some hazardous materials, such as natural gas, are flammable and can cause explosions. Even turning on a light switch or using a radio may create a TOXIC CHEMICALS Various industrial chemicals are used across many industries, and they may be found in a gas, aerosol, liquid, or solid state. These chemicals can be hazardous either because of the chemicals they contain (e.g., carcinogens, reproductive hazards, corrosives, or agents that affect the lungs or blood) or because of their physical properties (e.g., flammable, combustible, explosive, or reactive). Large quantities of these chemicals may pose a risk because of exposure through routine use. Many types of toxic chemicals, particularly pesticides and fertilizers, are used in agriculture. Use protective clothing before entering a scene that may contain pesticides or other chemicals. If necessary, call a haz-mat removal team. If you know which pesticide was involved in a particular emergency, check the label for instructions and precautions, and take the label with you to the hospital. Before transporting a person, remove all clothing and flush the person’s body with water. In any of their states (gas, aerosol, liquid, or solid), toxic industrial chemicals could enter the body by being inhaled, ingested, or absorbed through the skin (see page 262 to 265). The time it takes for these substances to have an effect depends mainly on the route through which they entered the body. Generally, poisoning occurs more quickly if the chemical is inhaled. SDSs or chemical information cards will provide information on the effects of each chemical and the symptoms of exposure. If you or someone you are assisting is exposed to a toxic industrial chemical, get yourself and the person away from the area as quickly as you can. Avoid passing through the contaminated area if possible. Employers should have an effective plan in place to assist employees for reaching shelter safely. They may be required to shelter-in-place if they cannot get out of a building or if the only place with clean air is indoors. Health and safety plans should take into account the possible impact of a release of toxic industrial chemicals. Plans should include guidelines such as monitoring, detection, awareness training, PPE, decontamination, and medical surveillance of acutely exposed workers. Health Canada provides guidelines for the PPE requirements to be used during or after a toxic chemical release and when the duration of the chemical release or airborne concentration of chemicals is unknown. Details are available on the Health Canada website. WORKPLACE EQUIPMENT Many types of workplace equipment require special training: Never touch a control on a piece of machinery unless you are sure that you know what the control does. Chainsaws People who work with chainsaws must understand how to control hemorrhages and deal with crush injuries (described in Chapter 9), so it is recommended that chainsaw operators hold an emergency first aid certificate. Operators should always carry a first aid kit that includes a largewound dressing, and they should have reasonable access to a more comprehensive kit. It is also important to consider the health risks that chainsaws pose to operators due to high levels of noise and hand-arm vibration. These risks can be controlled by using low-noise/low-vibration chainsaws, providing suitable hearing protection, maintaining chainsaws and protective equipment regularly, and providing operators with training on the health risks associated with operating chainsaws. Workplace Vehicles Before trying to extricate a person from industrial/ agricultural equipment, the equipment must be stabilized and shut down. It might be necessary to contact a specialized crew to perform this task (Figure 24–6). Figure 24–6: If necessary, call specialized personnel, such as the fire department, to stabilize and shut down heavy equipment. As a general principle, these vehicles can be stabilized, if necessary, using the techniques described in Chapter 19. The vehicle should be shut down by entering the cab to access the main controls. The engine should be slowed down with the throttle and then the machine switched off using the ignition key. Some diesel-powered machines are shut down via an air shut-off lever rather than an ignition key. The engine can also be shut off by shutting the fuel line. This is done using the shut-off valve at the bottom of the fuel tank or using vice-grip pliers. If a diesel engine cannot be shut down and the person is in a life-threatening situation, a 9-kilogram (20-pound) CO2 fire extinguisher can be emptied into the air intake. This will shut down the engine but will also cause considerable damage to it. Ride-on Rollers/Compactors Those who work around or operate rollers/ compactors face risks of injury related to a machine rollover or being struck by the machine or its components. Measures must be taken to prevent injury or death. WORKPLACE Workplace equipment includes power tools, such as chainsaws, and also the many specialized vehicles used in industrial and agricultural workplaces (e.g., tractors, forklifts, and combines). 409 Develop site-specific safety plans for all aspects and stages of the job. Have the safety plans analyzed by a qualified person to determine the safest possible methods for performing the work. Provide all workers on site with training in sitespecific safety procedures and for hazards they may encounter at the site. Continually evaluate safety plans to address changing conditions at the work site. Minimize the presence of workers on foot near machinery. Use barriers to separate workers, pedestrians, and vehicles from moving equipment. Provide appropriate protective equipment, such as high-visibility reflective vests and hard hats. Ensure that workers use and maintain this equipment. Ensure that machines are not operated on grades steeper than those specified by the manufacturer. Make sure that all of the manufacturer’s safety features are operational. Tractors/Forklifts Most tractor fatalities occur as a result of crush injuries following a rollover. Ensure that the tractor has been fully stabilized before attempting to extricate a trapped or injured patient. An injured person trapped by a tractor can be freed by digging a trench underneath the person’s body or by cutting off a piece of the machine, such as the steering wheel. In some cases, however, the tractor may need to be lifted off the person by a specialized team. Be aware that tractors can be fueled by diesel, gasoline, or propane: If fuel is leaking, this creates a serious fire hazard. WORKPLACE Power Take-Off (PTO) 410 A power take-off (PTO) is a device used to transfer power from an engine (e.g., in a tractor) to another piece of equipment (e.g., a brush mower being towed by the tractor). When the engine is running, the PTO shaft rotates at engine speed, transferring energy from the engine to the attachment. PTOs cause many injuries on the farm. Injuries can occur when clothing becomes snagged or tangled in the rotating shaft. Amputations often occur in this situation, and these injuries are often fatal. PTO injuries around tractors can also occur due to any of the following factors: Many older tractor models lack PTO shields, or have damaged or ineffective shields. PTOs may be engaged without operator input. For example, if a PTO shaft is attached to a moving tractor but is not also attached to an accessory, the rotating shaft may catch onto clothing, limbs, or hair and cause injury or death. Some farm equipment must be running in order to make adjustments or correct malfunctions. Since PTO shafts rotate when the equipment they are attached to is operating, a worker may be exposed to the rapidly spinning PTO shaft while examining the equipment. Work practices, such as clearing crop plugs, may expose operators to PTO shafts. Defective PTO shafts can disconnect from the machinery they are attached to. If so, they may swing and/or break off, striking anyone within range. Combines A combine is a large agricultural vehicle used to harvest and thresh grain. Dangerous areas on a combine include: The auger, which is the rotating part of the screw conveyor. The heads, with their oscillating cutting bars. The reels, which are steel tines that can impale a person. The snapping rollers, which can cause crush injuries (Figure 24–7). The combine’s reverse feature should never be used in an attempt to extricate a patient from a combine. Since the safest approach to protect a patient is to prevent the machinery from moving, pry bars and other tools should be used to jam the moving parts in place before beginning extrication. The hydraulic system must be locked. Usually, a bar near the hydraulic cylinder will lock the header. If possible, the combine header should be separated from the drive mechanism. An acetylene torch can be used to cut off pieces of the combine to free a patient, but the combine and surrounding soil should be washed down first and the inside of the combine flushed to reduce the risk of fire. If a patient is trapped inside the auger, the augur may need to be cut free, in which case it should be transported with the person. First, a large pipe wrench should be wedged on the shaft to prevent it from reversing, and then the auger drive should be disconnected. Do not attempt to extricate a patient in the field if the auger has caused an avulsion. On older equipment, rescue tools can be used to spread snapping rollers, but this approach will not work on newer equipment. Hay balers compact hay and straw into bales by exerting tremendous force. To free a person caught in a hay baler, the tines may need to be disassembled by unscrewing the bolts that are holding them together. The belts that drive the cross auger or raise the auger may need to be disassembled with rescue tools. To prevent reverse motion, a pipe wrench can be used to hold onto the input shaft as the auger is cut free. To release a person from the smooth rollers, the mounting bolts at each end should be removed to remove the bearings. An acetylene torch should never be used to take apart a hay baler, as the combustible dust inside the baler may ignite. Other Agricultural Hazards Grain Auger A grain auger is a long tube used to raise and transport grain from the ground to the top of grain bins, load trucks from a grain bin, or carry feed from a wagon to cattle feeders on a farm. It has a long, screw-shaped shank driven by a pulley or gear at the top. As the shank turns, the grain moves upwards in the tube. On a per-hour-ofuse basis, augers are one of the most dangerous machines used in agriculture. Figure 24–7: Combine parts, such as the auger, heads, reels, and snapping rollers, can cause serious injuries. Common injuries that result from operating grain augers include: Amputations: Contact with and/or entanglement in the exposed screw at the intake end of the auger’s shaft often results in amputations. Soft tissue injuries and fractures: An auger’s sharp corkscrew blade rotates as it draws grain up. Coming into contact with an unguarded blade can result in worker mutilation. Electrocutions: Electrocution often occurs when moving a raised grain auger around the farm and coming into contact with electrical wires. Silos The major hazard in a silo is the gas formed during fermentation of stored crops, which, if inhaled, can kill a person within minutes (Figure 24–8). Keep in mind that silo gas can leak out to the surrounding area. Signs of this gas include a bleach-like smell, the presence of dead birds and insects, a yellowish or reddish vapour, and sick livestock nearby. Specialized teams are usually required to extricate a patient from a silo. A self-contained breathing apparatus (SCBA) must be worn to rescue a patient in the presence of silo gas. Administer supplemental oxygen to the patient and place him or her in the rapid transport category. WORKPLACE Hay Balers 411 Manure Storage Manure is often flushed from livestock facilities into a holding pond or a closed structure. This creates hazards including toxic fumes and the risk of drowning. To rescue a person in a manure storage area, you must wear an SCBA and a lifeline. Treat an immersed or submerged person as you would a drowning patient. Before transporting the patient, remove any contaminated clothing and flush the patient’s body with water. Do not bring any contaminated materials into the transport vehicle. Anyone and everything that came into contact with manure will require decontamination. Livestock WORKPLACE There are more injuries each year from farm animals than there are from tractors or machinery. Poor judgment and lack of understanding of animal behaviour are the main causes of accidents. Livestock have unique vision characteristics, sensitivity to noise, and strong territorial instincts that need to be understood before handling them. Never enter an area with unsecured livestock. Treat injuries inflicted by livestock as you would any similar injury, but be sure to flush animal feces from any wound. 412 Figure 24–8: The gas formed during fermentation of crops stored in a silo can kill a person within minutes if inhaled. SUMMARY Requirements for a First Aid Attendant The first aid attendant of a workplace must: Have current certification at the required level. Maintain his or her knowledge and skills. Be prepared to respond both alone and as part of a first aid team. Provide all care in a professional manner. Provide care within the scope of his or her training. Thoroughly document any first aid-related actions and process paperwork  according to legislative requirements. Report to the supervisor and joint health and safety committee as required. Conduct follow-up with the ill or injured person approximately 3 days after  the person returns to work. Be familiar with specific elements of the particular work site. Recommendations for Emergency Transport Vehicles (ETVs) Your workplace ETV should: Be capable of traversing the area it is intended to serve. Have headspace of at least 1 metre (3 feet). Provide protection from the elements (e.g., dust, sun, extreme temperatures). Allow effective communication between the driver and the first aid attendant, as well as between the vehicle and the hospital/medical director. Conform to any legislative requirements where it is operating. Name and occupation of ill or injured person Names of any witnesses Date report was completed Date and time report was received, response was made, care was provided, and (if applicable) care was handed off to advanced medical personnel Description of how the illness or injury occurred Description of the illness or injury Detailed description of treatment provided Description of any problems or shortcomings at the scene that may have  contributed to the injury or illness Description of the outcome Signature of both the first aid attendant and the ill or injured person (if possible) Description of the follow-up with the ill or injured person WORKPLACE Information Requirements for Proper Documentation 413