“First do no harm” is a fundamental ethical principle practiced among physicians and related healthcare professions throughout the world. OHS pros should be aware of its concepts.
Helpful vs harmful
OHS pros must consider the full range of helpful versus harmful arguments when making risk decisions. Arguments, for example, that use of face masks, vaccines, and disinfectants to limit the spread of Covid-19 are more harmful than helpful range from those that are scientifically plausible to most that are nonsense. Plausible to nonsense arguments are complex because of an abundance “fact” versus “false” information that may waver over time.
Dental X-rays: Helpful or harmful?
Is use of a lead apron to shield your reproductive organs helpful or harmful during a dental X-ray? The question is particularly meaningful if you had a dental X-ray within the last two years. Your historical perception likely suggests the lead apron is more helpful than harmful. But is that true?
The American Association for Physicists in Medicine’s April 2019 Policy Statement advises discontinuance of routine use of dental X-ray for the following reasons: 1) Patient shielding may jeopardize the benefits of undergoing radiological imaging; 2) Use of these shields during X-ray based diagnostic imaging may obscure anatomic information or interfere with the automatic exposure control of the imaging system; and, 3) These effects can compromise the diagnostic efficacy of the exam, or actually result in an increase in the patient’s radiation dose. Layperson’s words: Use of lead aprons were helpful during old methods for dental X-ray but are harmful with modern technology. Be aware, we must always consider risk with a fresh perspective.
Oxygen first aid: Helpful or harmful?
Is administration of bottled oxygen with face mask helpful or harmful during response to a medical emergency at the workplace? Assume the person that requires first aid is having breathing difficulties, is having chest pain, is semi-conscious, or is unconscious with a shallow breath. Common logic, particularly when we see how EMTs respond in the movies, is that administration of emergency oxygen is standard practice and must be helpful. But is this true?
The American Heart Association and American Red Cross first aid guidelines1 state “Despite the common use of supplementary oxygen in various medical conditions, there is little evidence to support its use in the first aid setting. Administration of oxygen is not considered a standard first aid skill. However, oxygen may be available in some first aid environments and requires specific training in its use.” Per the guidelines, first aid oxygen may be used in the following cases:
- The use of supplementary oxygen by first aid providers with specific training is reasonable for cases of decompression sickness;
- For first aid providers with specific training in the use of oxygen, the administration of supplementary oxygen to persons with known advanced cancer with dyspnea and hypoxemia may be reasonable;
- Although no evidence was identified to support the use of oxygen, it might be reasonable to provide oxygen to spontaneously breathing persons who are exposed to carbon monoxide while waiting for advanced medical care;
- There is insufficient evidence to recommend routine use of supplementary oxygen by a first aid provider for victims complaining of chest discomfort or shortness of breath; and,
- For individuals with suspected stroke, the routine use of supplemental oxygen by first aid providers is not recommended.
Administration of emergency oxygen should only be given in the above situations. This advice excludes emergency oxygen use in most workplaces. Further, providing oxygen to a non-hypoxic person is equivalent to administering a drug. A Pulse Oximeter must be used to determine a hypoxic condition. Providing emergency oxygen to a person experiencing an ischemic stroke (87% of strokes are ischemic) may increase risk of cerebral reperfusion injury – that may increase mortality. If your workplace has emergency oxygen for first aid, what is your risk decision: Leave the tanks in place or remove them?
Creating harm when we think we are doing good may occur in many OHS situations. Installing asbestos in buildings to reduce fire risk is a major historical example. Here are some other examples that may spark your curiosity:
- Machine guarding. Guarding that creates new pinch points or other new hazards such as obscuring safe view of equipment operation.
- PPE. New PPE that poorly fits some workers such as loose-fitting gloves that prevent a safe grip on a lifted part.
- IH sampling. Industrial hygiene results that may contain false negatives giving a false belief that exposures are at safe levels.
- Chemical substitution. Substituting a chemical that is a known or suspected carcinogen for one that does not pose carcinogen risk; but giving less than full consideration for other health risks such as reproductive.
- Grade inflation. Passing workers from an OHS training class when they have not demonstrated competency on the topic.
- OHS competency. Making decisions as an OHS pro when not fully competent on the topic.
- Quantity over quality. Creation of numerous OHS documents when fewer will suffice. For example, ISO 45001:2018 OHS Management System, A.7.5 Documented information, states “It is important to keep the complexity of the documented information at the minimum level possible to ensure effectiveness, efficiency, and simplicity at the same time.”
- Unconscious bias. Treating people different from you, differently – without being aware of this action.
- Compliance over conformance. Focus on OSHA compliance requirements while minimizing OHS conformance recommendations e.g., ISO 45001 that are necessary to keep workers healthy and safe.
- Management over workers. Supporting management is a necessity. But OHS priority is about keeping workers free from injury or illness.
- Status Quo. Sometimes a smooth sailing ship needs to be rocked a bit to achieve urgency for continual improvement.
- Over-confident. Being confident is a necessary trait among OHS pros. Being overly confident is a negative trait.
- Favoring obvious over root cause injuries.
- Focus on unsafe acts over unsafe conditions.
- Treatment for acute cause of illness at expense for treatment of chronic health hazards.
I am certain you may have a lot more to add.
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