First aid recommendations once thought effective have recently been found insufficient and, in some cases, more harmful. The science behind first aid guidelines has been reevaluated, and, as a result, changes are coming in training practices and real-world applications.

Estimating occupational illness numbers is a tricky thing. The Archives of Internal Medicine (AIM) estimates more than 60,300 fatalities result from occupational illnesses annually. In contrast, the Bureau of Labor Statistics has reported 121 deaths. To further emphasize the point, the Occupational Safety and Health Administration (OSHA) says 6,000 people die each year from workplace injuries, and another 6 million workers suffer non-fatal workplace injuries at an annual cost of more than $125 billion to U.S. businesses.

Whatever the high number, would your first aid knowledge be sufficient if a coworker struggled for life in the machine shop, on the factory floor, at an outdoor site or in the cubicle next to yours?

Which begs the question, what is sufficient first aid?

As many IMT readers are engineers and other science-minded professionals, it seems safe to assume that any in-place practice should require some sort of proof that it is adequate — some evidence — wherein, like science and (hopefully) medicine, the scientific method is applied to gain objective confirmation that it works. So shouldn’t first aid protocol, too, have adequate evidence backing it?

Such is the posited idea that recently saw the American Safety & Health Institute (ASHI) join 25 other nationally recognized organizations on the 2005 National First Aid Science Advisory Board (NFASAB). Co-founded by the American Heart Association Inc. (AHA) and the American Red Cross (ARC), NFASAB recently was charged with reviewing and evaluating the latest scientific literature (statistics and data) on current first aid protocols — in order to answer some of the many questions concerning current first aid treatment recommendations. The board reviewed research, came to a consensus and released their recommendations as the updated 2005 first aid guidelines.

As it turns out, scientific evidence for first aid treatment was found scarce or lacking in many critical areas. Questions remain unanswered. For example, according to Ralph M. Shenefelt, a paramedic and member of the 2005 NFASAB, and Les Johnson, director of client services for the national headquarters of St. John Ambulance Canada, in a recent Occupational Hazards article:

We need to know more about the benefits of occupational first aid training: What is the effect on injury rates, severity and cost? Do different educational approaches produce different behavioral outcomes in first aid-trained workers? Do these outcomes translate to effective care? How much does effective first aid care reduce the physical and fiscal impact of occupational injury and illness?

In not having scientific evidence, a notable number of recommendations today are based on practical experience and the consensus of experts.

During the NFASAB evidence evaluation process, “controversy emerged in critical areas such as the use of tourniquets, pressure points and extremity elevation to control life-threatening bleeding,” according to Johnson and Shenefelt, who is also executive program director of the American Safety & Health Institute, the third-largest training accreditation organization in the United States. Likewise, issues arose in less-critical areas such as a preference for triple-agent antibiotic ointment over double- or single-agent antibiotic ointment for superficial wounds.

Take the long-held recommendation to keep syrup of ipecac on hand for emergency treatment of poisoning, for instance. Syrup of ipecac, in fact, has never been proven effective and can even be harmful, according to Shenefelt and Johnson. For someone who has ingested poison, NSAFAB now recommends that the victim NOT be given syrup of ipecac, nor water or milk, as guidelines previously allowed in certain cases after consultation, as these substances may be additionally harmful.

As well, earlier guidelines that recommended elevating a bleeding limb above heart level and, if direct pressure is ineffective, pressing on specific arterial points, were also found to be lacking in sufficient evidence. Now it is recommended, quite simply, that firm pressure be applied until bleeding stops or paramedics arrive.

For musculoskeletal trauma — such as sprains, strains, contusions and fractures — the injured should receive cold application for no more than 20 minutes. NFASAB suggests cooling via a plastic bag or damp cloth, with solid ice because it melts, with a barrier (e.g., a thin towel) between the cold container and skin.

Thermal burns? Despite common practice, direct application of ice to a burn has been found to potentially cause more harm. Thermal burns now should be treated with cold water ASAP, but first aid providers should avoid cooling victims’ burns with ice or ice water for longer than 10 minutes.

These are a few of the revised guidelines for such common procedures. Training material revision, publication and rollout by every national and international training organization is expected to occur throughout 2006.

In the workplace, providing first aid training to all employees, rather than limiting it to a small number of designated First Aid Providers, may help reduce both the frequency and severity of occupational injury and illness. Beyond the science, there is much that remains unknown about the first aid interventions that are recommended — not only in the workplace but also in the home and anywhere else accidents may happen.

Earlier: Eliminating Workplace Boo-Boos

Sources

Science to the Rescue: Learning What Works in First Aid
by Ralph M. Shenefelt and Les Johnson
Occupational Hazards, May 1, 2006

Best Practices Guide: Fundamentals of a Workplace First-Aid Program
OSHA, 2006

American Red Cross and OSHA Sign Alliance to Save Lives
American Red Cross, May 19, 2005

Prepare a Safer Workplace and Protect Your Most Valuable Asset: Your Employees
American Red Cross

United Support and Memorial for Workplace Fatalities (USMWF)

OSHA Workers’ Page

Additional

What Safety Excellence Managers Do
by Larry L. Hansen, CSP, ARM
Occupational Hazards, May 12, 2006