Fire Fighting and First Aid in Victoria, Australia

(This article is reprinted with permission from Safety at Work Magazine.)

A ‘Code of Practice for First Aid in the Workplace' was introduced by the (now) Victorian WorkCover Authority, Health and Safety Division on June 1, 1995. This code does not offer any prescriptive guidelines for levels of training or first aid equipment but rather directs employers to individually assess their compliance for workplaces and emergency requirements to establish appropriate levels of first aid training and equipment.

Previously, three levels of training were prescribed as a minimum standard, but the new code moved towards specific workplace solutions for first aid depending upon the specific workplace hazards and risks.

First aid is usually specifically directed to the needs of the workforce. However, it was recognised that first aid in the response role of an emergency service may need to be directed to members of the public, and the Metropolitan Fire Brigades Act details "such other measures as appear necessary for the protection of life… [or property]."

Establishing what is appropriate

When reviewing the medical requirements for firefighting, it is critical to understand the environmental factors that essential firefighting functions are performed in and affected by:

• Operate both as a member of a team and independently at incidents of uncertain duration.
• Spend extensive time outdoors exposed to the elements.
• Tolerate extreme fluctuations in temperature while performing duties. Must perform physically demanding work in extremely hot and humid atmospheres while wearing equipment that significantly impairs body cooling.
• Experience frequent transition from hot to cold and from humid to dry atmospheres.
• Perform a variety of tasks on slippery, hazardous surfaces such as on rooftops or from ladders.
• Work in areas where traumatic or thermal injury is possible.
• Face exposure to physical, chemical and biological hazards that require the safe and effective use of appropriate protective equipment.
• Wear personal protective equipment that weighs approximately 25 kg while performing these tasks.
• Perform physically demanding work while wearing positive pressure breathing equipment that has approximately 38mm of water column resistance to exhalation at a flow of 40 liters per minute.
• Perform complex tasks during life-threatening emergencies.
• Work for long periods of time, requiring sustained physical activity and intense concentration.
• Face life or death decisions during emergency conditions.
• Exposed to situations that may give rise to critical incident stress.
• Make rapid transition from rest to near maximal exertion without warm up periods.
• Operate in environments of high noise, poor visibility, limited mobility, at height, and in enclosed or confined spaces.
• Drive and operate heavy vehicles and use manual and power tools in the performance of duties.
• Rely on senses of sight, hearing, smell and touch to help.

Nature of Hazards and the Severity of Risks

Firefighting by its very nature includes exposure to numerous hazards (something with potential for harm) and risks (the likelihood that given a hazard, harm will occur).

Pertaining to firefighting, the following broad categories of hazard and risk are identified:

1. Physical: Thermal, electromagnetic radiation, noise, vibration, pressure changes, confined spaces, energy exchange (falls, strike object)
2. Biological: Viral, blood and body fluids, bacterial, parasitic
3. Chemical: Solids, liquids, gases, aerosol, dust (asbestos, synthetic, wood, metals, biological), smoke, fume, fibres, mist

All hazards have the capacity to contribute to harm and produce acute (immediate) or chronic (delayed) effects.

First aid usually is required when actual or potential harm follows a brief exposure to a hazard, often involving relatively high exposure levels with rapid onset of effects.

First aid is performed to remove an individual from continuing harm and to provide safe and effective intervention which may include basic life support until more advanced support becomes available, whilst at the same time ensuring the health and safety of the first aider is preserved.

In its most benign (and common) form, first aid often provides definitive treatment. In its most extreme form effective first aid forms the first key link in the chain of survival. Firefighting by its very nature (as identified within the essential firefighting functions) involved the need to ‘maintain personal safety and make critical decisions in a confused, chaotic and potentially life threatening environment, throughout the duration of the operation'. The level of need for a specific and professional first aid response (in firefighting) is unlikely to be exceeded by any other occupational group in the general community.

Life–threatening events (fire-fighters):

The required first aid response and equipment is dependent upon the environment in which they operate eg. urban or rural, and the availability and nature of back-up paramedical and medical support. The chain of survival in first aid (where life is at risk) is dependent upon the integrity of each link in the chain.

The links are:

1. Early access to trained first aid provider
2. Basic life support – early CPR
3. Advanced life support – early defibrillation
4. Tertiary medical care – advanced cardio pulmonary life support

The following first aid equipment must be considered:

1. First aid kit including face shield/pocket mask AND self inflating air bag
2. Oxygen with suction
3. Defibrillation
4. Full hospital facilities

Training and equipment must be proportional to the expected first aid incidents as detailed in the risk analysis.

Life-threatening situations for firefighters are most likely to include respiratory and cardiac events. In the context of dramatic collapse due to heart attack, which is a realistic risk in firefighting, as a minimum we would recommend familiarity with defibrillation equipment and technique. Even if not administered by firefighter first aid providers, it would contribute to the safe and effective assistance by them to other advanced life support personnel within the chain of survival. Of course, provision of defibrillation equipment, and training of first aid providers in its use would be in the best interests of a firefighter should they be in the unfortunate position of requiring such treatment.

Sudden death as a result of firefighting duties is not well documented in Australia. However, there is broad agreement within emergency services in Australia and overseas that a basic level of fitness is preferred for the safety of the individual firefighter (inferring risk).

It is accepted that firefighters respond in emergencies by making a rapid transition from rest to near maximal exertion without warm up periods. This activity has the theoretical and practical risk of sudden death from heart attack or cardiac arrhythmia (abnormal rhythm). In this situation and ideally the immediate provision of CPR must be accompanied by basic life support and automated defibrillation, within 4 minutes, if resuscitation is to be successful. Early defibrillation is fast becoming part of the standard first aid approach to safety in the workplace.

Australian research regarding the cardiac risk to firefighters under maximum exertion is lacking. Past anecdotal evidence has identified that heart disease has a major historic association with firefighting.

Life-threatening events (general public):

The same principles apply for first aid assistance to the general public as those applying to fire-fighters. It must be acknowledged however that there is a public expectation that firefighters (and other emergency service workers) can respond to life-threatening emergencies with a level of professional competence greater that that seen in the general community.

The presence of MFESB members at incident scenes usually precedes other emergency service workers. The public is not interested in whether the firefighter is trained or not in first aid, they expect the officer to respond to any emergency and take charge.

The Brigade Officer should be well trained and equipped to deal with not just fellow officer injuries, but major life-threatening events as well. This should include the ability to maintain basic life support, which is enhanced by the provision of oxygen and airway suction. Familiarity with automatic defibrillation equipment and technique would be preferred, for the safe and effective assistance of advanced life support personnel within the chain of survival.

The introduction of SAED technology has enabled traditional and non-traditional emergency first responder groups to attempt defibrillation before the arrival of advanced life support providers.

Biological Exposures

The perceived risks of emergency service workers in relation to their own health and safety (whilst performing first aid) frequently relate to biological hazard exposure. There are over 150 recorded post exposure incidents (across emergency services) of blood and body fluid exposure, and in the majority of cases exposure has resulted from poor preparedness for first aid and lack of use or absence of appropriate equipment.

The risk in these instances of transmission of blood-borne infections can be minimised and is best managed by appropriate levels of training. Provision of self-inflating air bags and/or oxygen therapy and suction would provide another level of protection, whilst also providing an additional resuscitation aid. In Brigade experience blood-borne infection transmission risk ahs occurred where CPR has been performed either unprotected, or with protective face shields or pocket masks.

First Aid Practices

The hazards and risks identified in firefighting would require the following first aid course components:

• Management of basic first aid including operator and victim safety
• Universal precautions
• Basic life support
• Cardiopulmonary resuscitation
• Use of oxygen and suction
• Use of defibrillation

While a significant part of the analysis and planning for firefighter first aid has taken account of occupational health and safety considerations, in addition there must also be in-depth knowledge of the management of:

• Altered conscious state
• Respiratory distress/disorders
• Painful musculoskeletal injuries
• Major bleeding
• Shock
• Fractures
• Eye injuries
• Seizures
• Burns
• Heat stress
• Decontamination procedures
• Snake bite management, (although a less common urban risk, it should be taught to any firefighter in Australia, whether rural or urban)

All first aid practices should reflect nationally recognised standards of first aid care.

SUMMARY

Firefighting carries with it the potential for exposure to a variety of predictable hazards and risks. The safety of individual firefighters is dependent upon the level of training and equipment provided to fulfil the expected tasks.

First aid in the workplace is dependent upon the identification of hazards and risks, and the appropriate first aid responses to those situations.

Minimum response should include the ability to manage the use of oxygen, including suction, for safe cardiopulmonary resuscitation in life-threatening situations. The day-to-day hazards and risks for firefighters include the need to provide first aid for firefighters and also for members of the community, where the need for an effective and safe response is immediate.

Safety at Work Magazine is an occupational health and safety magazine published bimonthly by Workplace Safety Services Pty Ltd. To order a subscription, visit www.worksafety.com.au.

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