XI. Emergency Care
A. GENERAL CAUTION!
This section is not a substitute for proper first aid training by the American Red Cross or other agencies. It is only a guide to help you remember the most important steps in administering first aid. Recommendations are derived from current policies of the American Heart Association, American Red Cross, and American Academy of Orthopedic Surgeons.
- First aid is the immediate and temporary care given to the victim of an accident and sudden illness until professional medical help can be obtained.
- First aid kits sufficient for the number of employees shall be provided at all logging sites and in all personnel transport vehicles. First aid kits shall be regularly inspected and replenished as needed. It is everyone's responsibility to be familiar with the contents of these kits and to acquire basic first aid knowledge.
- In the event of an accident or emergency, immediately summon medical assistance and be sure to give complete directions to the accident scene.
- While awaiting medical assistance, follow these procedures:
a. Check the victim's breathing. If the victim is not breathing, open the airway by opening the mouth and tilting the head back. If breathing does not resume spontaneously, maintain the open airway and perform mouth-to-mouth resuscitation.
b. Check for heartbeat. If the victim does not have a heartbeat, perform cardiopulmonary resuscitation (CPR) if qualified.
c. Check for injuries. Perform emergency first aid as outlined in this section.
- Accident victims must not be moved unless it is essential to protect their lives or to prevent additional injury.
- If the victim is conscious, reassure them. Keep them calm and quiet, and treat for shock while awaiting medical assistance.
- Use personal protection to prevent transmission of bloodborne pathogens.
B. FIRST AID AND CPR TRAINING
- All employees shall be trained in first aid and CPR methods by a qualified instructor.
- The first aid and CPR training shall consist of at least the following:
a. Definition of first aid.
b. Legal issues of applying first aid (Good Samaritan Laws).
c. Basic anatomy.
d. Patient assessment.
e. First aid for respiratory arrest, cardiac arrest, hemorrhage, lacerations/abrasions, amputations, musculoskeletal injuries, shock, eye injuries, burns, loss of consciousness, extreme temperature exposure (hypothermia/hyperthermia), paralysis, poisoning, loss of mental functioning, and drug overdose.
g. Application of dressings and slings.
h. Treatment of strains, sprains, and fractures.
i. Immobilization of injured persons.
j. Handling and transporting injured persons.
k. Treatment of bites, stings, contact with poisonous plants or animals.
- First aid methods prescribed by the American Red Cross, the Mine Safety and Health Administration, or equivalent organizations are suggested to be used for training.
- First aid and CPR training must be documented in writing and training must remain current.
C. ARTIFICIAL RESPIRATION
Artificial respiration is the procedure for causing air to flow in and out of the lungs by artificial means when natural breathing stops. Breathing stoppage may be due to accidents such as electric shock, drowning, or asphyxiation, or from internal medical problems. A life may be saved if you act quickly.
- Turn the victim on his side and clear the mouth and throat of all foreign material (chewing gum, food, loose false teeth, etc.).
- Place the victim on his back. Keep the head tilted back by placing fingertips under the bone of the chin and the other on the forehead. Use the fingers of the hand on the forehead to pinch the victim's nose closed.
- Seal your mouth, or breathing shield if one is being used, over the victim's, and blow air into the lungs.
- Ensure that the air you blow into the mouth does not leak out of the nose (keep the nose pinched shut) or leak from around the mouth (form a tight seal with your lips). The victim's chest must rise when you blow.
- Blow vigorously into an adult's mouth (gently into a child's mouth) until you see the chest rise, then remove your mouth and allow the victim to exhale.
- Repeat inhalations every four to five seconds for adults (every three seconds for children). Continue artificial respiration until the victim revives or until qualified medical personnel take over.
D. SEVERE BLEEDING
Bleeding from open wounds can usually be stopped by direct pressure. Disposable rubber gloves should be worn when treating bleeding wounds.
- Use a sterile compress of cloth if available. Otherwise, use a clean handkerchief, towel, or cloth.
- Place the compress over the wound and press directly on the compress with your hand.
- If the compress soaks through, place additional compresses over the wound and continue direct pressure. Do not remove compresses once applied.
- Elevate the injured part as high as possible over the victim's body to reduce blood flow and allow the blood to clot.
- Treat the victim for shock.
- If these efforts fail to stop the bleeding, apply firm pressure to the nearest recognized pressure point until bleeding stops. If all of these measure fail to stop bleeding on an arm or leg, a tourniquet may be considered. The decision to apply a tourniquet is a decision to risk the sacrifice of the limb in order to save a life. Once the tourniquet is applied, do not loosen or remove it. Write the time and location that the tourniquet was applied on a note attached to the victim and have them transferred as quickly as possible to a medical facility.
E. SNAKE BITE
- First aid treatment in addition to the above, depends on organizational policy or recommendations from local physicians.
- Attempt to identify or kill the snake.
- Keep the victim quiet and calm. Do not allow the victim to move around unless absolutely necessary.
- Try to keep the bitten part lower than the rest of the body.
- Cover the wound with a sterile compress.
- If possible, place the affected area in cold water or wrap with a cold wet cloth or ice wrapped in cloth.
- Treat the victim for shock. Be prepared for possible breathing difficulty and be ready to administer artificial respiration if needed.
- Transport the victim to medical help. If possible, notify them you are bringing in a snake bite victim and the type of snake if known.
- If possible bring the dead snake to the medical facility so appropriate anti-venom may be administered.
Shock is the term used to describe adverse body reactions to injuries, infections, heart attacks, and other sudden body changes. Traumatic shock occurs after an accident or injury and results in poor blood circulation, loss of consciousness, and in some cases death. All injury and accident victims should be treated for shock using the following procedures:
- Keep the victim quiet and lying down.
- Cover the victim to prevent body heat loss.
- Victims with head injuries should have their heads slightly elevated. (Caution: Do not move victims who have suspected neck, back, or spinal injuries.)
- Victims without head, neck, or back injuries may have their feet elevated 8 to 13 inches to improve blood flow to head.
- Victims who cannot receive medical attention for an hour or more and who are fully conscious and do not have head injuries may be given small amounts of water. If the victim is vomiting, has convulsions, or is nauseated, do not give any fluids. Never give fluids to a semi conscious or unconscious person.
G. OTHER PROBLEMS
1. HEART ATTACK
Symptoms: Persistent chest pain, shortness of breath, pale color, weak feeling, shock.
Treatment: Keep the person calm and quiet. Do not allow the person to walk. Loosen tight clothing and make the person comfortable. Help him take prescribed medication when available. Obtain medical assistance.
Symptoms: Paralysis or weakness of one side of the body. Difficulty breathing, talking or swallowing.
Treatment: Keep the victim's mouth and throat clear. Keep the victim calm and quiet. Obtain medical assistance.
3. HEAT STRESS DISORDERS
It is vital that you not only understand heat stress and how it affects you but, more importantly, what steps you can take to avoid it. Heat stress occurs when the humidity, air temperature, radiant heat, and too little air movement combine with heavy physical work and clothing to dehydrate the body and raise the body temperature beyond safe limits. Perspiration, as it evaporates, is the body's main defense against heat. By vaporating, perspiration cools the body. In high humidity sweating becomes profuse but does not evaporate, so no heat is lost. When body fluids lost through sweating are not replaced, the body's heat controls break down and subject the body to heat stress.
a. HEAT CRAMP
These painful muscle cramps are caused by the imbalance of salt and other minerals in body fluids. Drinking lightly salted water, tomato juice, or commercial "athletic" drinks in moderation will help maintain a proper balance of salt and other minerals.
b. HEAT EXHAUSTION
Heat exhaustion is caused by inadequate water intake, salt and mineral losses, or both. It is characterized by wet, clammy skin; body weakness or extreme fatigue; unstable walk; nausea; and collapse. Heat cramps are often associated with heat exhaustion. Treatment includes rest in a cool place and drinking lightly salted fluids in moderation.
c. DEHYDRATION EXHAUSTION
This form of heat disorder may occur after several continuous days of work in the heat. If daily water losses are not replaced, progressive dehydration can severely reduce work capacity. Body weight loss is a key indicator of progressive dehydration. A loss of 2% or more is often accompanied by diminished work output. Exhaustion and collapse may follow weight loss exceeding 5%. Treatment includes fluid replacement and rest.
Heat stroke results when the body's heat controls totally fail. This condition is characterized by:
- Hot, dry skin.
- High body temperature.
- Mental confusion, delirium, loss of consciousness, convulsions or coma. Heat stroke is a medical emergency. Begin treatment immediately and obtain medical assistance. Brain damage and/or death may result if treatment is delayed. First treatment is to cool the victim quickly. One method is to soak the clothed victim with cold water and vigorously fan to promote evaporation. Continue until the victim's body temperature drops, then proceed to treat for shock.
e. HEAT STRESS PREVENTION
It is not enough to know how to recognize and treat heat disorders. You must know how to prevent them. The two important keys to preventing heat stress are physical fitness and acclimatization.
Maintaining a high level of physical fitness is one of the best ways to protect yourself against heart stress. Workers who are physically fit adjust or acclimate to work in the heat almost twice as fast as others. Workers in poor physical condition who are also overweight are even more unsuited for work in the heat. Their greater weight produces more heat without a proportionate increase in surface area for cooling.
A person acclimated to work in heat runs less risk of heat stress. The body adjusts to hot working conditions in four to eightdays by:
- Increasing sweat production.
- Improving blood distribution.
- Decreasing skin and body temperature.
- Decreasing heart rate.
Always adjust to hot weather activity gradually. Set a reasonable pace, take frequent breaks, replace fluids, and do not expect full production until the body acclimates. Specific steps to prevent heat stress are:
- Replace fluids: Drink a lot of fluids to prevent dehydration:
a. Drink 1 or 2 cups of juice or water before beginning work.
b. Drink fluids frequently during each hour of work.
c. Drink as much as you can at lunch and at the evening meal.
d. Continue replacing fluids throughout the evening.
- Replace salt: Replace salt lost through sweating. Fit, acclimated workers should be able to accomplish this with normal salt intake at meals, but do not overdo it. Too much salt impairs temperature regulation, and heat disorders become more likely. Avoid salt tablets.
- Replace potassium: Potassium can become depleted over extended periods of work in the heat. Make potassium-rich foods such as bananas and citrus fruits a part of your daily diet. Drink lemonade or tomato juice to replace lost fluids. Commercial "athletic" drinks also help make up potassium losses.
- Establish good work habits: There are individual differences in heat tolerance. Know your own limits and work to them.
- Take rest periods: Work-rest cycles must be adjusted to prevent progressive fatigue. Rest frequently in cool, shaded areas to minimize heat buildup and progressive fatigue.
- Stress Can Add Up. Physical work in a hot environment is very demanding. The following factors can combine to create even greater stress on the body:
b. Carbon monoxide (a by product of fire)
4. EYE INJURIES
- If acid, caustic, or other irritating liquids get into eyes, flush eyes with large amounts of water.
- If objects get into eyes, place a sterile bandage over both eyes.
- If an object is stuck in the eye and protruding, place a cup over the eye and blindfold both eyes.
- In all eye injury cases, take the victim to medical help.
5. SPRAINS AND DISLOCATIONS
Elevate injured extremity. Apply cold packs to reduce swelling. Splint to prevent movement. Seek medical assistance.
Immediately cool the affected areas using cold water or cold packs. Cool for minimum of 30 minutes, if help has not yet arrived. Cover area with sterile dressing. Treat for shock. Obtain medical assistance.
7. BROKEN BONES
Immobilize broken bones and adjacent joints using splints and bandages. Treat victim for shock. Seek medical assistance.
8. INSECT BITES
Cool affected areas with cold water or cold packs. Stay with the victim in case of an allergic reaction. If the victim has a history of allergic reactions, treat for shock, help take prescribed medication when available, and seek immediate medical assistance.
- If victim is coughing or if air exchange is satisfactory, let the victim continue to cough.
- If a complete obstruction is present and breathing ceases, attempt to dislodge stuck particles. By grabbing the victim from behind, make a fist with your hand, and place it below the ribs. Grasp your fist with the other hand, and press firmly in and up to dislodge particles. Repeat until obstruction is removed.
- If the victim loses consciousness, lay the person on his back and place both of your hands palm down on the victim's upper abdomen. Give several firm upward shoves to attempt to dislodge obstructions. If breathing does not return spontaneously after the blockage is cleared, begin artificial respiration.
H. ADDITIONAL SUGGESTIONS
1. Reassure the victim while awaiting medical help.
2. Keep calm.
3. Render required first aid measures promptly and correctly.
4. Whenever possible, avoid moving a seriously injured victim.
5. Always check a victim of accident and sudden illness for a medical alert identification tag (bracelet, necklace, etc.). Notify medical authorities if a medical ID is found.
I. FIRST AID KITS
- The employer must provide first aid kits at each work site where felling is being conducted, at each landing, and on each employee transport vehicle.
- The number of first aid kits and the content of each kit shall reflect the degree of isolation, the number of employees, and the hazards reasonably anticipated at the work site.
- 5. Keep local emergency service telephone numbers available on the job site, and readily accessible to all personnel.
- The number and content of first aid kits may be reviewed and approved annually by a health care provider.
- The employer shall maintain the contents of each first aid kit in a serviceable condition.
- The following is deemed to be the minimally acceptable number and type of first aid supplies for a small logging work site consisting of two (2) or three (3) workers. When larger operations or multiple operations are being conducted at the same location, additional first aid kits should be provided at the work site, or additional quantities of supplies appropriate for the operation size should be available in the first aid kits.
- Each first aid kit shall contain at least the following items:
- Gauze pads (at least 4" x 4")
- Two (2) large gauze pads (at least 8" x 10")
- Box adhesive bandages (Band-Aids)
- One (1) package gauze roller bandage at least 2" wide
- Two (2) triangular bandages
- Wound cleaning agent such as sealed, moistened towelettes
- Adhesive tape
- Latex gloves
- Resuscitation equipment, such as resuscitation bag, airway, or protective facemask
- Two (2) elastic wraps
- Directions for requesting emergency assistance
Other suggested first aid items to include are:
- 2" bandage compress
- 4" bandage compress
- Gauze compress, 24" x 72"
- Burn cream
- Ammonia inhalants
- Merthiolate swabs, 1/2 cc
- Stingrest swabs, 1/2 cc
- Indelible marking pen
- Cold pack
- Butterfly closures
- Eye kit
- Hand mirror
- Diphenhychamine hydrochloride elixir or capsules