Every minute counts
With this in mind, employers need to be able to respond during the first minutes of emergencies in the workplace with some degree of confidence.
How can employers achieve a greater degree of preparedness? The best answer is by establishing workplace Medical Emergency Response Teams (MERT). These teams are made up of employees trained to care for the sick and injured until the arrival of professional emergency medical responders.
Additionally, as automated external defibrillators (AEDs) become more common in the workplace, MERT members can also be the lead employees in responding to incidents of sudden cardiac arrest (SCA).
What OSHA requiresThe OSHA â€œAccess to Medical Careâ€ standard (29 CFR 1910.151) provides basic guidance on workplace medical response:
â€œIn the absence of an infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees, a person or persons shall be adequately trained to render first aid.â€ [29 CFR 1910.151(b)]
OSHA has supplied clarification on 1910.151 stating that for worksites that have the potential for severe injuries (such as electrocution or falls from heights), medical care must be provided within three to four minutes. For worksites that have no potential for severe injury, the standard is 15 minutes.
For organizations relying upon local emergency medical services (EMS) for response, even the best EMS systems would have a difficult time consistently meeting the three-to-four-minute standard. These workplaces are the ideal choices for the creation of a MERT.
However, with the introduction of AEDs and the recognition of sudden cardiac arrest as a significant problem that often leads to death, relying on the 15-minute standard could be problematic.
MERT â€” a useful additionIn the event of sudden cardiac arrest, rapid response with an AED is essential. For every minute that goes by after the start of SCA until an AED is applied, there is a ten percent decrease in survival. In the United States, there are nearly 300,000 SCA events. Survival rates vary and, while there is no nationally compiled percentage, survival generally is estimated at only five percent.
As a result, CPR/AED responders, as part of a broader MERT program, may be a useful addition to ensuring a safer workplace.
Medical Emergency Response Teams are trained to respond to the most common types of workplace injuries and illnesses. These can include:
- Sudden cardiac arrest
- Heart attack
- Respiratory compromise (breathing difficulties)
- Injuries due to falls, explosion, machinery, and hazardous materials.
The level of care provided by MERT members is basic, often described as first responder care (although in many states the term â€œfirst responderâ€ refers to a specific level of medical certification). The goal of a MERT response is to provide basic care until arrival of emergency medical services.
Activating the teamMembers of a Medical Emergency Response Team will vary depending on the type of business or industry. Some programs are made up of employees who volunteer, while other employers require participation as part of the job description. No matter the situation, the basic requirements are the same.
An important consideration is MERT activation. Two areas of emphasis are needed. First is a general awareness within the organization of the team. All employees need to be oriented to the teamâ€™s existence and function.
Second is response activation. Employees must know how to activate the team. This can be through a common telephone number such as the security office or reception area. Alternatively, accessing the overhead or telephone paging system may be more suitable for some smaller workplaces. From there, activation of individual team members can be through pagers, radios or overhead (public address) announcements.
Because the MERT is a supplement to the local EMS, not a replacement, part of the activation plan needs to assure that a call to the local 911 or other emergency dispatch agency is made.
Training needsBasic training needs for MERT members should include CPR/AED training and first-aid training. Several organizations provide programs that include both of these training elements, such as the American Heart Associationâ€™s Heartsaver First Aid course.
In addition to CPR and AED training, the most basic first-aid courses will include general patient assessment, bleeding control, burn management and medical emergencies. Additional training specific to the risks associated with the workplace, such as environmental issues or hazardous materials contact, may need to be added.
Any medical responder should also receive bloodborne pathogen training. This requirement, outlined in 29 CFR 1910.1030, reviews necessary actions for employees who may be exposed to blood or bodily fluids. Many providers of first-aid training can also address this training issue.
The use of emergency oxygen may vary by state and is dependent on each stateâ€™s regulations regarding who can administer oxygen. While emergency oxygen delivery has very few risks, some states do require a higher degree of certification beyond basic first-aid to administer it. If permitted, emergency oxygen administration can be included in the training program. For most providers of first-aid training, this will involve a supplemental class.
Equipping the MERTOSHA recommendations for first-aid equipment refer to ANSI standard Z308.1. While many OSHA documents will refer to the 1978 standard, ANSI updated that standard in 1998. The ANSI standard is very basic and capable of supplying a MERT member with basic equipment to handle most injury incidents (see â€œWhat every MERT needsâ€ sidebar).
Some additions to the ANSI standard kit, when combined with first-aid training, will provide the MERT with a more versatile response kit. These additions include:
- Eye protection
- CPR mouth shield or barrier device
- Eyewash or sterile saline flush solution
- Microbial hand wipes or soap.
Site-specific treatment items based on the unique characteristics of each workplace is another consideration. These can be based on response recommendations from the MSDS for products used at the workplace.
Lastly, including an AED to the MERT resources will allow for a timely response for sudden cardiac arrest.
With a combination of training, equipment, policy and procedures, and a team of employees dedicated to helping their fellow employees, customers or visitors, a Medical Emergency Response Team can help mitigate the effects of injury or illness.
SIDEBAR: What every MERT needsAccording to ANSI Z308.1-1998, the minimum contents for a first-aid kit are:
- (1) absorbent compress â€” 32 sq.-in.
- (16) 1x3 adhesive bandages
- (1) adhesive tape â€” 5 yds.
- (10) antiseptic applications
- (6) burn treatment applications
- (2 pairs) medical gloves
- (4) 3x3 sterile pads
- (1) triangular bandage
SIDEBAR: AED to the rescue: How one companyâ€™s program saved a lifeBy Doug Hakala
With virtually every person at risk for sudden cardiac arrest, the need for having an automated external defibrillator (AED) program is obvious. The U.S. Occupational Safety and Health Administration (OSHA) has encouraged employers to take advantage of AED technology, noting that 13 percent of workplace fatalities are caused by sudden cardiac arrest. OSHA claims about 400 workplace deaths from sudden cardiac arrest are reported to their agency annually.
Last year, the American College of Occupational and Environmental Medicine (ACOEM) surveyed 400 of its members working in major corporations and businesses and found that 34 percent of those who have implemented an AED program have used their AED at least once in order to help save a life. The survey also showed that 66 percent of victims of sudden cardiac arrest in the workplace were successfully revived.
Put to the testSeveral Medtronic customers have reported that their AEDs have been used to resuscitate workers who have been victims of sudden cardiac arrest. One customer â€” Panasonic â€” implemented its AED program in its corporate headquarters in Secaucus, N.J., in the spring of 2001. With eight AEDs and 50 employees trained in CPR and AED use, their program was tested for the first time when an employee went into sudden cardiac arrest in August of 2002. The companyâ€™s medical unit nurse, Carole Garoffolo, a security officer and other employees moved quickly, activated their AED plan and thanks to shocks from an AED and emergency medical care, the employeeâ€™s life was saved.
Implementation tipsPanasonic took basic steps in implementing an AED program including:
1) Contacting the American Heart Association to learn more about AEDs.
2) Contacting local medical centers and emergency services to find out the brand of AEDs they use.
3) Having either the American Heart Association or the manufacturer of the brand of AEDs the company has selected evaluate the facility and determine the number of AEDs needed on-site as well as the number of people to be trained in AED use.
Garoffoloâ€™s medical unit oversees the medical direction for Panasonicâ€™s AED program. She coordinates refresher-training courses and recruits new employees to be trained as employees leave the company.
More meaningfulNancy Chrust, senior manager of benefits and employee services for the company, said there were no barriers to starting their program. â€œOnce it was determined that our use of AEDs would be covered under the Good Samaritan Act, the company could be less concerned about liability,â€ she said.
â€œSaving one person is more meaningful than any expense incurred,â€ said Chrust.
Doug Hakala is senior manager, Commercial Markets, Medtronic Emergency Response Systems.