There has long been discussion about the self-administered use of tourniquets to manage severe bleeding for injuries in our industry, and whether these devices should be included in first aid kits. There has also been debate about the use of some of the first aid equipment, originally provided to military personnel, such as haemostatic dressings and ‘pressure’ bandages, e.g. the ‘Israeli dressing’.
Historically, first aid training protocols precluded these items on the grounds that they were specialist (when first aid training was generic) and potentially presented a risk to the patient if used incorrectly.
However, there has been a growing recognition within the tree work sector that the type of injuries that workers may receive, particularly when working with chainsaws, can be managed most effectively using these types of first aid equipment. During the past few years there has also been an increase in the availability of sector-specific first aid training (the ‘+ F’ suffix, indicating it is aimed at those working in forestry and tree work activities).
The Arboriculture and Forestry Advisory Group (AFAG) has raised this issue with HSE on a number of occasions, requesting that guidance be updated, and in August the HSE Tree Work web pages were updated to reflect changes in relation to personal first aid kits.
HSE advises that personal first aid kits should now contain one or more haemostatic dressings and a tourniquet, rather than as previously advised a large wound dressing, for situations where control of a significant haemorrhage is required. See the relevant page here.
The guidance now states:
First aid kit
You should carry a personal first aid kit on you while at work. Make sure you have received suitable training on using its contents. It should contain at least one or more haemostatic dressings, a tourniquet, a pair of plastic gloves and a Resusciade (or similar device). Keep a worksite first aid kit at a central location.
The HSE considered it was not necessary to outline the additional items that may be carried in a personal first aid kit, or indeed the contents of the larger worksite first aid kit, which should be identified as part of the relevant risk assessment process.
The HSE also notes that suitable first aid training for tree work should include how to apply a haemostatic dressing and a tourniquet, as well as when such products should be used. Clearly such items should not be included in first aid kits until operators have had suitable training in their use.
While this HSE guidance has been written primarily for ground-based tree work operators, climbing arborists should consider what level of first aid equipment is carried in their personal kits. A haemostatic dressing should now be carried in preference to the standard large wound dressing (provided the climber has been adequately trained in its use); the decision on whether a self-administered tourniquet will be appropriate for use in the tree, as opposed to an immediate self-rescue, for example, needs to be risk assessed and considered in each climber’s circumstances and for the operations they are carrying out. It is suggested that plastic gloves and a ‘Resusciade’ are not essential in a climber’s personal first aid kit but must be immediately available in the aerial rescue kit, and the main worksite kit.
Don’t forget to check your and your workers’ first aid training is kept up to date. Do try to access the ‘+ F’ type courses as these will be most applicable to your working circumstances. When booking such courses, please confirm with the provider that the use of haemostatic dressings and tourniquets will be included in the training.
This article was taken form Issue 187 Winter 2019 of the ARB Magazine, which is available to view free to members by simply logging in to the website and viewing your profile area.