The Case for Enhanced First-Aid Training for Lineworkers
Imagine you are working in a remote wilderness area on difficult terrain. The job involves setting poles, running wires, trimming trees, operating heavy machinery and working at elevation in track bucket trucks or hooks on a pole. The potential for serious injury is present, and extrication will be difficult if an injury occurs.
This scenario begs the question, are basic first-aid and CPR training enough for a situation like this? Should enhanced first-aid training be considered for remote utility work? Could training some of our lineworkers in advanced first aid help them more effectively respond? Would training them help them to recognize potentially hazardous situations in advance to avoid injuries altogether?
As a utility worker with medical experience, I believe enhanced first-aid training should be considered, especially for remote work. This article will explore the need for and benefits of this type of training for utility employees. Many of our field workers have witnessed horrific injuries and fatalities during the course of their workdays. While it is certainly tragic for those who suffer these debilitating injuries or death, it is also traumatic to witness these events and be part of rescuing your co-workers. For example, imagine being part of a five-man crew in a rear-lot situation during which you hear the pole crack and then watch as two workers roll down an embankment, still attached to the pole that just failed and fell to the ground. You hear their screams and see the angulated upper thigh of one worker; the other has obvious facial fractures and is bleeding from the mouth. As your hands shake while attempting to call 911, you realize you have no cellphone service. It will be at least an hour before help arrives.
Practice for Emergency Events
Engaging in table-top simulations of these types of events can help organize an emergency response as well as help identify areas of need. One of those areas may be the treatment of an injured worker before help arrives. During an emergency, questions may rush through your mind. If you find an angulated fracture, will you straighten it or splint it in the position in which you found it? Is it a joint injury or a long bone fracture? Can you get the injured worker on the track machine and get them out of the remote area? Do you have a tourniquet? If so, are you trained to use it?
There are several different types of training that may apply. Emergency medical technician (EMT) training would be terrific for lineworkers; however, it requires a significant time investment. Wilderness first-responder training may be closer to the knowledge needed in remote environments. The National Ski Patrol is not recognized by most state prehospital medical certifying authorities, but certification through the organization is similar to receiving EMT certification, with an emphasis on addressing patient trauma and extrication. Additionally, so-called “stop the bleed” training would certainly be appropriate and would help save a life if serious bleeding were encountered.
In the U.S. military, medics are part of the team. Not everyone is trained to the level of the medic, but everyone pitches in to help when needed. Should workers in remote locations and rights-of-way follow a model similar to the military’s?
Low-Probability/High-Consequence Emergencies
What other emergency situations might outdoor industrial athletes encounter? Let’s say you are working on a 100-degree day and one of your workers collapses in the bucket aloft. He is breathing but unconscious. What’s your plan? Or maybe one of your workers heads into the remote transmission line early with a track digger. The rest of the team gets delayed, so he starts digging holes by himself. But the digger starts to slide, and he jumps. When you arrive, you find him on the ground with one leg trapped up to his pelvis under the digger. He’s talking to you but can’t feel his leg. He says he’s been there for 90 minutes. What should you do? Or perhaps one of your co-workers falls 30 feet off the pole. He has pain in his lower back and says he feels like he has to defecate. He explains that if he moves, it feels like something is crunching in his pelvis. Or what if your co-worker, who is a Type 1 diabetic and has an insulin pump, becomes unconscious in the bucket? What’s your plan when 911 is an hour away and the injured party needs to be extricated?
These emergencies fall into a category I refer to as “low probability/high consequence.” But it’s the responses to these types of infrequent emergencies that are the very things we need to practice to maintain a level of skill. CPR, for example, is necessary to save someone whose heart has stopped. If you do CPR until you get tired, it is unlikely that person will survive. Full recoil (i.e., hands coming off the chest) after every compression is necessary to properly perfuse the coronary arteries that feed the heart muscle.
Fact vs. Fiction
There are many myths around medical care that are not helpful. In this article I have mentioned heat stroke, bleeding, angulated fractures, cardiac arrest, pelvic fractures, crush injuries and diabetic emergencies. Below are a few facts and myth busters about each for you to keep in mind.
- Heat stroke: Cool the patient immediately. The brain protein begins to denature (dissolve) at 105.8 degrees Fahrenheit, causing permanent brain damage or death. Cooling the patient very quickly can cause a seizure; however, the seizure is not as bad as not cooling the patient enough.
- Bleeding: Bones can be broken in the same limb as a tourniquet is needed. Do not stop tightening the tourniquet because the patient screams. Stop tightening it when the bleeding stops.
- Angulated fractures: These are arms and legs bent at grotesque angles. If it is the long bone that is broken and not the joint, straightening the limb can reduce further damage and pain. If the jagged bone ends are allowed to remain angulated, that can contribute to “compartment syndrome,” which occurs when the swelling becomes so bad that the skin acts as a tourniquet and shuts off nerve and blood supply. Permanent limb damage can occur.
- Cardiac arrest: High-quality CPR, swapping off with a partner every two minutes when possible, and the use of an AED provide the best outcomes for patients. Full recoil with each CPR compression is necessary.
- Pelvic fractures: If a person’s pelvis is broken, liters of blood can pool in the pelvic cavity and then bleed out internally. How you move these patients matters. Do not roll them and be sure to treat them gently. A pelvic splint can be helpful. A shirt or sheet tied around the pelvis can be very helpful.
- Crush injuries (also known as “smiling death”): If a person is found with part of their body crushed for one to two hours (two extremities for one hour or one extremity for two hours), there is a protocol to follow before removing the offending item from the person. If the item is removed too quickly, the person will smile from the relief and proceed to immediately die from the rush of toxins back into their bloodstream.
- Diabetic emergencies: Do you know that the insulin pump should be turned off if a diabetic person becomes unconscious? Do you know how to do it?
Conclusion
According to Todd Conklin in his book “Pre-Accident Investigations: An Introduction to Organizational Safety,” “Things that never happen, happen all the time.” The truth is that most field workers are not well-versed in medical care. Our first-aid training is more of a mandatory compliance factor than a useful addition to our box of tricks. We rely on 911 to be there to save us when we need it. But in remote areas, logistics create some roadblocks. Add to this the fact that Americans are getting bigger, not taller. Per the Centers for Disease Control and Prevention, the average male over age 20 is just over 5 feet 9 inches tall, weighs 198 pounds and has a 40.5-inch waist size. Approximately 75% of prehospital providers are overweight or obese and unprepared for wilderness rescue. Their jobs are high in stress but also require a lot of sitting. If you are working in remote areas, I believe in most cases you are hoping nothing bad happens, yet you likely have not practiced for an emergency response to the various worst-case scenarios. Perhaps it would help to have someone within your crew who is trained in medical treatment and evacuation. Further, being prepared for what might happen may also shine a light on unrecognized hazards – those things that may create situations that lead to severe injuries and/or death.
In closing, devising and sharing a mental model of how your team responds to emergencies has a number of immediate positive effects. Creating an environment in which it’s safe to speak up and practicing hazard communication both help to get everyone on the same page. Practicing rescue scenarios – such as having the apprentice operate the ground controls and communicate with the rest of the crew to lower an injured co-worker – improves confidence if and when the real thing occurs. In my opinion, I don’t see a downside to becoming more prepared by having a small percentage of the team receive greater medical training. What do you think?
About the Author: Bill Martin, CUSP, NRP, RN, DIMM, is currently a safety consultant working in safety and training for Northline Utilities LLC and Northeast Live Line. He has held previous roles as a lineman, line supervisor and safety director. Martin also owns and operates Think Tank Project LLC (www.thinkprojectllc.com) for consulting and speaking opportunities.
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