According to the HSE, there were 171 fatalities at work in 2010-11, an increase of 24 on the total of 147 deaths in 2009-10. In addition, more than 24,700 workers also suffered a major injury in 2010/11. Following the rise, the agency is pressing employers to ensure they make tackling risks, to their employees a top priority.

These provisional figures show that on average, 6 in every million workers were killed at work between April 2010 and March 2012. There were 50 deaths in the construction industry, 34 in agriculture and 9 in the waste and recycling industry. These deaths make up more than half or all workplace deaths in the UK during 2010/11.

In the Yorkshire & Humber region, there were  24 deaths and 2,609 major injuries, compared with 23 deaths and 2,741 major injuries during 2009/10. to add to these figures, another 8,854 workers suffered an injury or ill health which required them to take at least three days off work in 2010/11, compared with 9,309 the previous year.

Paul Spurrier, Head of Operations for HSE in Yorkshire & the Humber, said “The families of the 24 workers in our region who lost their lives last year had to face Christmas and a New Year without them. While there was a welcome fall in the number of major and other injuries in Yorkshire and Humber, there were still hundreds of workers who have had their lives changed forever by a major injury”.

One of the big complaints from the HSE is that many employers send their staff on generic, off the shelf training courses, or get them to undertake E learning sessions. Whilst these provide staff with basic knowledge, quite often they fail to give those attending, the practical training and fact based knowledge they need to help them carry out their duties in a safer manner.

The reason that most generic courses fail to result in an improvement of safety standards is that the training is not tailored to meet the needs of staff as identified by a meaningful assessment of the activities they are involved in. In his report, Paul Spurrier goes on to say that “employers should spend their time tackling the real dangers that workers face rather than worrying about trivial risks or pointless paperwork”.

As an advisory service, we are often presented with risk assessments compiled by our clients. Some are very good but it is obvious that many are based on perceived workplace risks, rather than real risks. At one distribution site, all employees were required to wear high viz garments, not just those working in vehicle movement areas. Another is where everyone had to use blue plasters at a company which distributes pre-packed meals.

These may seem to be petty examples but they demonstrated a lack of understanding of what a risk assessment is meant to achieve. And while on the face of it, such attention to detail appears to present sites where health & safety matters are dealt with effectively, at both sites, our own assessors found serious safety issues where there was a high risk of injury, which had never been recognised or dealt with.

For example in the first instance quoted, where all staff were made to wear high viz jackets to reduce the risk of being hit by vehicles operating in the main yard, no assessment was made regarding the practices carried out by drivers, which included using 7 ½ tonne lorries to push stacks of supermarket type goods trolleys across the yard.

One way, death and injury rates in the workplace can be reduced, is for employers to take the time to better understand what the aim of conducting a risk assessment is and how effective assessments can guide them towards providing more effective training for their staff. This will then ultimately reduce the incurred through workplace accidents, and wastage on procedures and training which result in little or no obvious improvements in safety or productivity.

“While the increase in deaths is depressing, it is important to remember that the UK still has one of the lowest workplace death rates in Europe” says Paul Spurrier. “It’s important to remember that we still have one of the lowest rates of workplace deaths in Europe, but one death is still one too many.  I’d urge businesses to help cut the number of deaths in 2012.”

The Beacon school in Chesham Bois, is an independent day school for boys aged 3-13 years. Having been dissatisfied with the quality of training offered by other providers, the school Matron, Lyn Cole booked us on trial, to run an HSE approved 1 day Emergency First Aid at Work course for 30 of the schools staff, using 3 instructors.

The reviews from the staff were so positive that it led to us running a 2 day paediatric course and being booked to run another emergency first aid course, later this month.

Lyn, who was on the paediatric course said, “it was excellent and the information was delivered in a clear and concise manner which was suitable for all levels of  knowledge. We will be using Aline Associates again, I would highly recommend them”.

Here are some of the other comments made by the staff who have attended the courses so far.

1 day HSE approved Emergency First Aid at Work course. course. Caroline Yolland - Fantastic presentation format & knowledge of subject. Thank you.

Frazer Thomas – Very good and useful. Simple to follow and understand, many thanks.

Kathryn Johnstone - Right level of practical work Vs lecturing of information.

Kate Stanley – excellent – Well presented with some good methods to help remember things.

2 day paediatric course. Gwyneth Brown-Love – The instructor more than met my expectations, an excellent two days.

Niki Pendered - Excellent knowledge and interesting, all relevant, not boring. Suitable for all staff not just those with medical knowledge.

Jacqui  Evans - I felt at ease, the instructor got across what we had to know in a way that was easy to understand.

The survival rate for cardiac arrest is low, due partly to the fact that most people don’t know how to do CPR, and few are willing to have a go. The BHF campaign aims to address this by getting more of those not trained in CPR (compressions and mouth to mouth ventilation) to have a go at giving compressions only.

Research has shown that one of the main reasons untrained people don’t attempt CPR is the fear/reluctance associated with giving ventilations. Only having to do the compressions it is hoped, will remove this factor and encourage more people to attempt (compression only) CPR. It is hoped that this will eventually lead to an increase in the survival rate which is currently only around 7-10% in the UK.

While the policy is supported by the UK Resuscitation Council, their 2010 guidelines state rescuers should  combine compressions with ventilations unless they are “unable or unwilling to give ventilations” in which case they should just give compressions. This is what is taught on first aid courses in the UK.

So why have two standards?  The answer is all about time. When the oxygen supply to the brain is cut off suddenly, the brain cells start to die within 3-4 minutes. If the supply is not restored within 10 minutes the brain itself will die.

The aim of CPR is not, contrary to what you are told on the TV, to re-start the heart, which would have stopped due to a blockage of one or more of the coronary arteries. The aim is to maintain the oxygen supply to the brain, slowing down the death of the brain cells. This buys time to get the casualty to definitive medical care where hopefully, they maybe able to restore the blood supply to enough of the heart muscle to reinstate circulation of blood to the vital organs.

It is estimated that when a person collapses in cardiac arrest they have around 5 minutes worth of oxygen in the blood so by just giving compressions you can still slow down the death of the brain cells. The problem with compression only CPR is that once this reserve is used up, the effectiveness of the compressions begins to drop.

The ambulance service aim is to get to emergencies like cardiac arrest within 8 minutes. While most services achieve an average response time of around 6 ½ minutes, the actual times can be much longer due to the geographical location of the incident, the number of calls being dealt with by the ambulance service and the quality of the information given to them.

CPR is not an exact science and there are other factors which will effect the likelihood of the casualty surviving. The gold standard at this time is, wherever possible to perform full CPR however,  there is no doubt that if we simply get more people “having a go” more people will survive.

But here we should raise a note of caution. While it is important to spread the message that it is better to do something rather than nothing, we must also make people aware that the adverts do not show how stressful/hard it is to give compressions, nor the fact that even if you do full CPR, most casualties will not (as seen in the advert) suddenly sit up and come back to life.

Although as a final point we should say that those who do survive, will owe their lives to those who stopped and had a go.

The Spartan Race

Last month we covered the Spartan (sprint) race at Cambridge. This is a 5k obstacle race, of which the Spartan web site sys – “Participants will confront obstacles ranging from the extreme to absurd”

The obstacles included, being hosed down with ice cold water, climbing up (and down) a wooden frame covered with plastic sheeting which was soaked with water and washing up liquid, crawling flat on stomach or back through an ice filled wooden box underneath barbed wire strands which were an inch or so from the runners head and back .

The Ice box

Over 1800 runners took part and we treated 52 of them. There were more casualties but a lot of those were medics themselves including a group of American Air Force paramedics, who used our stock to treat their friends injuries.

The day was very hot and we initially expected to have do deal with a lot of people with dehydration. In the end though the only people suffering that was us, as we had to work out of an inflatable air shelter. Nice to look at but hot as hell inside.

The main injuries turned out to be the usual suspects i.e. sprained/twisted ankles. We treated these by using the RICE method. We asked the injured runners to sit and Rest the limb whilst we applied Ice for 10 minutes. That done, we then strapped up the ankles using a (crepe) Compression bandage to give support to the injured area. This was followed up with the usual advise about keeping the injured area Elevated (which most ignored) and advice on regarding getting the injury checked out in A&E if it did not improve, or got worse.

Our Ambulance crew transported one runner to Hospital with a serious dislocation of the ankle where the circulation to the foot was being restricted.

We also had to deal with a lot of cuts and abrasions but the worst were caused by the barbed wire suspended over the ice crawl box. As the runners crawled out of the box they had to raise their heads up and some sustained quite nasty lacerations to the back of their heads.

Head wounds bleed profusely so most looked worse than they were but as the runners had had to crawl through mud and swim in a gravel pit, we also had to contend with the real risk of infection.

So the wounds were washed out with saline solution (sterile eye wash) and then for good measure cleaned out using an antiseptic solution. It can be difficult to find/dress minor head wounds due to hair but fortunately most of the runners had short hair, so in the most part, we asked them to hold a gauze dressing to the wound until it stopped bleeding. Then depending on the extent of the wound, we applied an adhesive dressing (where possible) to the wounds.

If you want to know more about the Spartan Race or if you dare to take part, go to their site at http://www.spartanrace.com

On the 30^th of June 2011, the BSi  (British Standards Institute ) introduced  BS-8599. A new national standard designed to update the contents of kits so they better meet the needs of works first aiders. The main changes are:-

• Gloves - There will be more gloves in the kits and these will be nitrile to meet NHS guidelines.
• Plasters and wipes – extra plasters and wipes to meet actual needs.
• Medium and large dressings – there will be less in kits to reflect likely use.
• Triangular bandages – less again as they are no longer used for lower limb immobilisation.
• Finger dressing – returned to kits to be used for finger(and other) injuries, too large for plasters.
• Burn dressings – much more effective way of treating burns and scalds than water.
• Adhesive tape – for fixing of  bandages (in place of safety pins) and non adhesive dressing.
• Shears – required for removing clothing from wounds and opening some bandage packaging.
• Emergency blanket – used for keeping casualties warm & treating those suffering clinical shock.
• Resuscitation aid – provides protection for first aiders performing resuscitation.
• Eye wash – added to the Travel kits as lone workers are unlikely to be able to access eye wash.

What the law says - Despite common belief, there is no such thing as an HSE approved first aid kit. The Health & Safety (First-Ad) regulations 1981 state’s: “An employer shall provide or ensure that there  are provided such equipment and facilities as are adequate and appropriate in the circumstances for enabling first aid to be rendered to his employees if they are injured or become ill at work”

So basically, you need to decide what to put in your works first aid kit, based on the types of injuries that your first aider may have to treat. The confusion comes because in the HSE’s Approved Code of Practice (ACOP), it states, “As a guide, where no special risk arises in the workplace, a minimum stock of first-aid items would normally be”  There then follows the list of contents on which current workplace kits are based.

So what should I do with my existing kits? – Firstly, ignore the hype that is already circulating that you have to have the new BSi kits. The HSE has said they will not be making the use of the new BSi kits mandatory.

We are expecting the HSE to shortly publish a statement on their web site confirming their position. While we have been given the provisional text of the statement, we will hold off adding it to this post until it has been officially released just in case they add anything else to it.  So watch this space.

Recently we provided two Ambulances to cover a corporate event in one of the London parks. While the event passed of peacefully, we had to deal with an unrelated incident.

Although it was dealt with quickly, the actions of those involved could have resulted in a much more serious outcome for others.

Basically some children on a trip to the park disturbed a wasps nest and two of them got stung.  A member of the public alerted the Parks Police who collected the children and brought them to us. While the stings were painful, both of the children were fine. All that was required was the application of some ice (not directly) to the stings and a bit of Antihistamine cream. And thus the matter was closed. Or so we thought.

At this point an Emergency Ambulance from London Ambulance Service (LAS) appeared. At first we through the Police had called them but it turned out that despite our crew being on scene, one of the staff looking after the children had called LAS as well. It turned out she had been told on a first aid course that if a child was stung, “you must call out an ambulance immediately”

We then found out that the child’s mother had also been called and was now on her way by taxi. Mum duly arrived and once she regained her composure, she took her child of for some TLC and the rest of the children continued with their trip. So all was well but the result could have been much different.

The LAS crew turned out to what had been called in as a life threatening emergency when in fact it was an everyday aliment, being dealt with by experienced Ambulance staff. The LAS crew quickly established they were not required but because mum was on her way, they could not leave until they had spoken to her.

Thus an incident which should have been dealt with in less than 10 minutes, resulted in both our and the LAS crews being tied up for over 45 minutes. For us it was not a problem but by calling out the LAS vehicle, it was effectively taken off the road for almost an hour for no reason other than someone had said “if a child is stung, you must call for an ambulance”

While we always say if in doubt, always treat a casualty for the worst, the most important part of first aid is to find out what has actually happened to the casualty. You can not hope to provide effective treatment if you do not know what treatment is required. By stopping and asking questions (just like Ambulance staff do) you can build up a picture in your mind of the situation. Your brain can then search out the information it has on the subject, work out what you are likely to be dealing with and suggest a course of action. The brain is clever. If you tell it what’s going on and it doesn’t think about the Ambulance, you probably don’t need one.

By tying up the LAS vehicle, the lives of others could have been put at risk as the ambulance cover for that part of London would have been depleted. This week a lady on one of our courses complained that she had to wait once for an hour for an Ambulance. This can happen. While the Ambulance Service aim to reach life threatening emergencies within 8 minutes, it is not always possible or their fault.

40% of all the emergency calls LAS attend result (as in this case) in their crews giving no treatment at all. The main reason for this is that people these days just react rather than do the sensible thing and stop for a moment to see what it is they need to react to. The problem is that if you are having a heart attack and need medical attention urgently, you don’t want to be told that your ambulance and crew has gone to the park.

The qualifying session for last weekends Monaco GP was brought to a dramatic halt in its closing moments by Sauber’s Sergio Perez’s horrific 175mph crash into the Nouvelle chicane.

Sergio’s car hit the Armco barrier on the track edge and then slid across the track, slamming into the barriers positioned at the apex of the chicane. Fortunately Sergio was released from Hospital after 2 days having escaped with just concussion and a bruised thigh.

Sergio was protected from a more serious impact with the mobile crane stationed at the chicane, by the TecPro barriers. These barriers are made out of flexible polyethylene and are designed to absorb and dissipate the energy of a car hitting it just like Cerebral Spinal fluid (CSF) which surrounds the brain.

CSF is a clear colourless fluid which occupies the spaces around and inside the brain and which is renewed four to five times each day. It contains proteins and glucose that provide energy to the brain as well as lymphocytes which guard against infection.

Amongst it’s many functions, it acts in a similar way to the TecPro barriers. When the head is thrown about violently, the brain is also thrown around. CSF acts like a buffer absorbing the kinetic energy of the brain, hopefully slowing it down enough to prevent it from hitting the inside of the skull which could lead to damage to the brain.

Concussion (from the Latin concutere “to shake violently”) is where the brain is thrown about but not seriously damaged (usually due to the CSF absorbing the force). Signs and symptoms can include short term memory loss relating to the event. On his release from hospital Sergio said “ “I remember how I started Q3 (Qualifying session 3) and I also remember some of the accident, (but) for the time being, I am missing some memories about what happened after the first impact and the rescue procedures”

Other symptoms include headaches, dizziness, vomiting, nausea, lack of coordination, visual disturbances, blurred, double and or tunnel vision. In about one in seventy incidents of concussion, the casualty may go into a convulsion. It is believed that the cause is related to temporary loss of motor functions (and not to epilepsy or more serious structural damage).

The treatment of concussion involves monitoring and rest. Symptoms usually disappear anywhere between a few hours and two to three weeks depending on the severity of the injury. The problem is that in the initial stages of an incident (12- 24 hours) a much more serious condition (compression) could be developing within the skull, but that is for another blog.

Finding the right course can be a problem as many training providers, create their own course names such as “early years first aid” and further confuse the issue by stating incorrectly, that only they or those providers affiliated to their organisation can deliver the required course.

So lets start with the course name. The major training providers and the NCMA (National Child Minders Association) call the course the 12 hour (2 day) paediatric first aid course.

The course standards are set out in the “Practice Guidance for the Early Years Foundation Stage” You can see this at: http://nationalstrategies.standards.dcsf.gov.uk/node/84490

With regards to who can run the course, all it says in the guidance is that the courses “must be approved by the local authority in whose area the early years provision is located”

Although most Councils have a list of providers they know of and recommend, in our experience they will accept a certificate issued buy a provider who like us, is an HSE (Health & Safety Executive) approved training organisation (in relation to running workplace first aid courses).

If you complete the course you will be issued with a certificate which is valid for 3 years. There is no refresher course as such. Before your certificate expires you need to re-take the full course to maintain your qualification. Having said that, 3 years is a long time to go without any reminder of what to do should an incident occur, so we always advise that anyone with any form of first aid certificate, should (as per current HSE guidelines) attend an annual skills update course.

If you would like a copy of our course information sheet or more information on the annual skills update course, just email us at
enquiries@aline-associates.co.uk

Last week we retrained a group of first aiders in the use of Automated, External Defibrillators (AED), you know, the box they use on TV to bring someone back to life. Everyone knows about them but do you know what they actually do?

In cardiac arrests, part of the heart muscle dies as a blood clot stops oxygen from getting to the tissue. While this is happening, the hearts electrical circuit can go out of sync causing the remaining cells to go in to fibrillation (i.e. they stop causing the heart to pump and just sit there quivering).

Most people think an AED re-starts a stopped heart, in fact it actually stops a fibrillating (quivering) heart in the hope that the cells in the heart will re-boot themselves just like a computer when it freezes and you have to turn it off then back on again.

The average UK survival rate for cardiac arrest is 7 to 10%. The most important factor determining survival is early defibrillation. The chances of successful defibrillation declines at a rate of 10% per minute, however, the survival rate can be up to 49% when an AED is used within the first five to seven minutes after the arrest.

While the use of an AED significantly increases the patients chance of survival, it does not guarantee it. Those using an AED should also be able to perform effective CPR, which will provide the cells in the brain and vital organs with oxygen, buying time to get the casualty to hospital and definitive care.

Many thanks for the kind comments regarding the content of the blogs.

What you see on the website is a combination of our postings on our Facebook site and new articles. We serialise some of the blogs on the Facebook site and then post them on the website.

So if you want to start to read the blog as it is forming or want to see pictures of us and our clients at work, why not follow us on Facebook and Twitter. Our site addresses for Facebook and Twitter are both under “Aline Associates”