Chapter14-FirstAidandEmergencyMedicalServicesFIRSTAIDAntonioJ.DajerFirstaidistheimmediatecaregiventovictimsofaccidentsbeforetrainedmedicalworkersarrive.Itsgoalistostopand,ifpossible,reverseharm.Itinvolvesrapidandsimplemeasuressuchasclearingtheairpassageway,applyingpressuretobleedingwoundsordousingchemicalburnstoeyesorskin.Thecriticalfactorswhichshapefirstaidfacilitiesinaworkplacearework-specificriskandavailabilityofdefinitivemedicalcare.Thecareofahigh-poweredsawinjuryisobviouslyradicallydifferentfromthatofachemicalinhalation.Fromafirstaidperspective,aseverethighwoundoccurringnearasurgicalhospitalrequireslittlemorethanpropertransport;forthesameinjuryinaruralareaeighthoursfromthenearestmedicalfacility,firstaidwouldinclude-amongotherthings-debridement,tyingoffbleedingvesselsandadministrationoftetanusimmunoglobulinandantibiotics.Firstaidisafluidconceptnotonlyinwhat(howlong,howcomplex)mustbedone,butinwhocandoit.Thoughaverycarefulattitudeisrequired,everyworkercanbetrainedinthetopfiveortendo'sanddon'tsoffirstaid.Insomesituations,immediateactioncansavelife,limboreyesight.Co-workersofvictimsshouldnotremainparalyzedwhilewaitingfortrainedpersonneltoarrive.Moreover,the"top-ten"listwillvarywitheachworkplaceandmustbetaughtaccordingly.ImportanceofFirstAidIncasesofcardiacarrest,defibrillationadministeredwithinfourminutesyieldssurvivalratesof40to50%,versuslessthan5%ifgivenlater.FivehundredthousandpeopledieofcardiacarresteveryyearintheUnitedStatesalone.Forchemicaleyeinjuries,immediateflushingwithwatercansaveeyesight.Forspinalcordinjuries,correctimmobilizationcanmakethedifferencebetweenfullrecoveryandparalysis.Forhaemorrhages,thesimpleapplicationofafingertiptoableedingvesselcanstoplife-threateningbloodloss.Eventhemostsophisticatedmedicalcareintheworldoftencannotundotheeffectsofpoorfirstaid.FirstAidintheContextoftheGeneralOrganizationofHealthandSafetyTheprovisionoffirstaidshouldalwayshaveadirectrelationshiptogeneralhealthandsafetyorganization,becausefirstaiditselfwillnothandlemorethanasmallpartofworkers'totalcare.Firstaidisapartofthetotalhealthcareforworkers.Inpractice,itsapplicationwilldependtoalargeextentonpersonspresentatthetimeofanaccident,whetherco-workersorformallytrainedmedicalpersonnel.Thisimmediateinterventionmustbefollowedbyspecializedmedicalcarewheneverneeded.FirstaidandemergencytreatmentincasesofaccidentandindispositionofworkersattheworkplacearelistedasanimportantpartofthefunctionsoftheoccupationalhealthservicesintheILOOccupationalHealthServicesConvention(No.161),Article5,andtheRecommendationofthesamename.Bothadoptedin1985,theyprovidefortheprogressivedevelopmentofoccupationalhealthservicesforallworkers.Anycomprehensiveoccupationalsafetyandhealthprogrammeshouldincludefirstaid,whichcontributestominimizingtheconsequencesofaccidentsandisthereforeoneofthecomponentsoftertiaryprevention.Thereisacontinuumleadingfromtheknowledgeoftheoccupationalhazards,theirprevention,firstaid,emergencytreatment,furthermedicalcareandspecializedtreatmentforreintegrationintoandreadaptationtowork.Thereareimportantrolesthatoccupationalhealthprofessionalscanplayalongthiscontinuum.Itisnotinfrequentthatseveralsmallincidentsorminoraccidentstakeplacebeforeasevereaccidentoccurs.Accidentsrequiringonlyfirstaidrepresentasignalwhichshouldbeheardandusedbytheoccupationalhealthandsafetyprofessionalstoguideandpromoteprev...
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