The Health and Safety Executive (HSE) are advising that they are currently carrying out a series of inspection visits of construction sites. The visits, which are unannounced, form part of an ‘intensive inspection initiative aimed at reducing death and injury in one of Britain’s most dangerous industries’.

According to the HSE, during 2009/10 42 workers died while working in construction. They intend to target the key areas which lead to deaths in 2009/10 which were refurbishment, repair and maintenance activities. Other areas subject to review include ensuring that sites are managing work at height safely, the risk of exposure to asbestos and that sites are generally in good order.

Philip White, HSE’s Chief Inspector of Construction, said:

‘This will be the fifth year that we have run the inspection initiative across Britain and we anticipate that that there will be examples of both good and bad practice – those where employers are taking all the measures they can to protect their workers and those where safety is way down the list of priorities.

A lax attitude to health and safety in one of the more dangerous industries is not acceptable, especially when many of the incidents are completely avoidable by taking commonsense actions and precautions. As we’ve demonstrated in previous years, we will not hesitate to take action if we find poor practice that is putting the lives of workers at risk.

This year, as part of ensuring risks from asbestos are properly managed, we will also be checking that, where appropriate, asbestos surveys have been carried out prior to any refurbishment work. Many workers believe that, because asbestos has been banned as a building material, it’s no longer a threat to them. But that simply isn’t true. Any premises built or refurbished before 2000 could contain asbestos.’

Internet link: HSE press release

“The life of a talented teenage swimmer could have been saved if first aid at the pool where she died had been continued, a coroner has found.

Sophie Konderak, 16, got into difficulty while training with Leicester’s elite performance team at Braunstone Leisure Centre in September.

An inquest heard she died from an undiagnosed heart condition. But coroner Catherine Mason said she could have survived if a defibrillator had been used. Sophie has been described as a “water baby”, who had ambitions to compete in the Olympic swimming team as well as to become a doctor. The inquest in Leicester heard a pool lifeguard was following training guidelines when she stopped carrying out chest compressions after Sophie started breathing again. But experts said they were in fact her dying breaths.

Coroner Catherine Mason said: “When Sophie became acutely unwell there was a window of opportunity to treat her. “Basic life support was given but not continued, in accordance with training. “Had it been continued and a defibrillator applied, on the balance of probability she could have survived.”

A statement from parents John and Lesley Konderak, of Leicester, read: “The shortfall in the level of training and the equipment available contributed to this.”

Extract from BBC news web site. http://news.bbc.co.uk/1/hi/england/leicestershire/8535486.stm

This again raises the issue of “Agonal Breathing” and the lack of understanding and the significance of this by a large number of first aiders. Please see last article below date 21st January 2010 for more information.

Visit YouTube at http://www.youtube.com/watch?v=ICODRFoWZkw to watch video for help in the recognition of Agonal Breathing.

The latest review of resuscitation protocols by the International Liaison Committee on Resuscitation resulted in some change being introduced by the UK Resuscitation Council on the 18th October 2010.

The changes were few, but still highly important and are summarized below.

• When summoning help, ask for someone to fetch an automated external defibrillator (AED) if one is available.
• Chest compressions: The depth of compressions had increased to 5-6 cm and the speed increased to a rate of 100 – 120 beats per minute. (Harder and Faster)
• Although this is not exactly a change, more emphasis has been placed on giving each rescue breath over 1 second. (Take no more than 5 seconds to administer 2 rescue breaths)
• When to stop CPR, again not exactly a change but more emphasis on not stopping CPR unless you are certain they are breathing normally. E.g. they show positive signs of regaining consciousness, such as coughing, opening their eyes, speaking, or moving purposefully AND start to breath normally. (Please read previous news entries on the subject of Agonal breathing)
• If other rescuers are available, change over every 2 minutes to prevent fatigue. Ensure there is minimum delay during change over of rescuers and chest compressions are not interrupted.
• Although “compression only” CPR is still an option this is only effective for a short period after arrest. It is recommended that chest compressions should be combined with ventilations where possible and should be taught as a standard, particularly to those with a duty of care (which includes first aiders).
• Paediatric CPR protocols have not been changed, but some confusion has been identified with people incorrectly reading the Resuscitation Council’s web site publications. Some are reading this to advocate a 15 – 2 ratio of compressions to breaths. This is the guidance for “Health Care Professionals” only. The correct reference for people with “a duty of care” e.g. first aiders is the “Adult Basic Life support Guidelines” under the heading “Resuscitation of children and victims of drowning”.

Further information can be obtained from the Resuscitation Council’s web site at resus.org.uk.

A recent study found that 30% of cardiac arrest victims were placed inappropriately in the recovery position! The main reason for this is that the rescuer did not recognise “agonal breathing”. Agonal breathing happens in up to 40% of sudden cardiac arrests. The guidelines 2005 were changed to try and address this issue – if a casualty is unresponsive and “not breathing normally” a rescuer should start CPR.

Agonal breathing is “one (often noisy) deep gasp every 10 – 15 seconds” It is easy to see why a first aider would not give CPR if they had not been trained to recognise it. Frustratingly, if a casualty has agonal breathing, they have a higher chance of survival, but not unless the first aider starts CPR. Remember – If a casualty is “unresponsive” and “not breathing normally” CPR should be commenced immediately.

Recently at the European Resuscitation Council Congress a humorous paper was presented comparing the CPR rates of students who sang Nelly the Elephant with those who sang Staying Alive by the Bee Gees and those who did not sing at all.

To achieve adequate coronary profusion, the rate of CPR compressions must be between 90 and 120 (always aiming to achieve the magical 100). Interestingly all participants managed to perform CPR compression within the acceptable level.

Between the two songs Nelly the Elephant came out best at an average of 104bpm, but, after questions it transpired that all participants had the opportunity of practicing with a metronome first, which probably explains why all the rates were within the acceptable range! A word of warning however – is that the study found that a higher proportion of those that sang did not compress the chest deep enough to maintain coronary circulation, which arguably is more important than the rate.

ERT’s view is that; in addition to the facts outlined above, we have a distinct fear that if first aiders are trained to do CPR singing a song, that’s exactly what they will do if actually called upon to perform CPR for real. The casualty will not obviously be concerned but, any friend, colleague or relative close by may, unintentionally be affected and distressed by such behaviour.

We consider it is more appropriate to encouraging students to concentrate on the issues of the rate and depth of compressions during CPR training than to dilute their skills by introducing musical guidance. We therefore do not to use or raise the issue of using these or any other songs in relation to CPR protocols. If however, the students raise the issue, the reasons will be used to explain why we do not believe it to be appropriate.

On the 1st October 2009 the Health and Safety Executive introduced new guidance and training courses for first aiders in the workplace.

It is a legal requirement for employers to undertake a first aid needs assessment. The Approved Code of Practice sates that; “An employer should make an assessment of first aid needs appropriate to the circumstances of each workplace”. A copy of the HSE First aid guidance can be downloaded free from the link below;

http://www.hse.gov.uk/pubns/books/l74.htm

A comprehensive guide to the new first aid needs assessment and assessments tool are available to download using the link below:

http://www.hse.gov.uk/firstaid/assessmenttool.htm

What is new?

The updated guidance has seen the introduction of a new HSE approved 1 day Emergency First Aid at Work (EFAW) course to replace the old “Appointed Person” course and a new 3 day First Aid at Work (FAW) course to replace the old 4 day course.

FAW courses involve at least 18 hours of training and are run over a minimum of three days. Training organisations offering the course need to be approved by HSE for this purpose. EFAW lasts for at least six hours of training and is run over a minimum of one day. It can be offered by training organisations approved by HSE or recognised awarding bodies of Ofqual/Scottish Qualifications Authority applying a training standard set by HSE for the delivery of EFAW.

Lists of suitable training providers and awarding bodies are available from HSE’s Infoline.

http://www.hse.gov.uk/contact/index.htm

FAW and EFAW certificates last for three years. Before their certificates expire, first-aiders will need to undertake an FAW requalification course or an EFAW course, as appropriate, to obtain another three-year certificate.

What has changed?

The way that you should carry out a First Aid Needs Assessment (Employers must do this by law).

1. There are now two types of approved First Aider.
2. The introduction of annual refresher training.

Do I need to retrain all my first aiders?

Employers will not be required to retrain all their first-aiders. First-aiders with a valid first aid at work (FAW) certificate will only enter the new arrangements when their certificate expires. This means that it will take three years post implementation before all first-aiders in the workplace are captured within the new training structure

Can existing First Aider at Work attend the new 2 day FAW Re-qualifying course?

Yes. The FAW Re-qualification course and the attendance criterion is unchanged.

Do I have to retrain my Appointed Persons on the new EFAW course?

It will depend upon the initial training they received. You need to check if the syllabus of their “Appointed Persons” course meets the present requirements for EFAW. If your first aiders were trained by Emergency Response Training Ltd, they will definitely have completed all subjects required by the EMFA approved syllabus. It would be reasonable therefore to use them as ‘Emergency First Aiders’ until their existing certificates expire, as the HSE highly recommend that all first aiders attend annual refresher course, you may wish to consider this.

What if a First Aid at Work Certificate has expired?

Your First Aider at Work (FAW) can attend the 2 day requalification course up to 3 months before or 28 days after their current certificate expires. The new certificate will be valid from when the old one runs out. If the certificate expires by more than 28 days the First Aider must attend the full 3 day initial course.

If the EFAW course syllabus doesn’t cover all the subjects appropriate to my organisations needs, can they be included in this course?

Yes, Our EFAW syllabus includes all the HSE required subjects but has optional additional subjects depending on your workplace needs. Where a course is undertake “in house” and you require additional specialist training, this can be included but more time may need to be allocated.

Who should attend annual refresher training?

The HSE strongly recommends that first-aiders undertake annual refresher training, over half a day, during any three-year FAW/EFAW certification period. Although not mandatory, this will help qualified first-aiders maintain their basic skills and keep up to date with any changes to first-aid procedures.

This first aid needs assessment flow chart shows the HSE’s recommended sequence of training.

This first aid needs assessment chart show the HSE’s suggested numbers of first aid personnel.

How many first aiders do I need?

The HSE have a leaflet explaining the assessment process and is available at; http://www.hse.gov.uk/pubns/indg214.pdf

HSE Proposed Changes – Background:

The Current First Aid in the Workplace provision is based on Regulations over 25 years old. Twenty five years ago the workplace was considerably different, heavy machinery was commonplace and a Health and Safety culture was next to nonexistent. Today accidents still occur but thankfully are rare in frequency and normally less serious in nature. However, we now have an aging workforce which has its own problems.

In 2002 the HSE started a review of re-matching the needs of industry with first aid provision.

The HSE are now moving forward with a range of changes.

Prerequisite:

The HSE has a remit to the employer and employee for aid provision in the workplace. Surprisingly, it has no legal responsibility to the training industry itself, except in setting adequate training standards. However the HSE will retain the responsibility of setting standards as this is part of their legal remit.

Finally, any changes must have the support of the employers so changes tend to be a compromise by giving in certain areas and taking back in others.

Although a considerable number of changes are proposed, only the main changes are listed here.

Changes – Training Courses:

1. The commonly known Appointed Person one day course (currently unregulated) is to come under the control of the HSE. It will be called Emergency First Aid At Work (EFAW). The HSE recommends a yearly refresher course (3 hrs) and a repeat of the full EFAW course every three years (6 hrs – mandatory). Trainees completing the EFAW course will be considered as first aiders.
2. The current 4 day First Aid at Work course (FAW) will be reduced to three days (18hrs). The HSE likewise recommends a yearly refresher (3 hrs) plus a two day (12 hr) requalification course every three years (mandatory).
3. The requirement for an Appointed Person remains. However, it is unlikely that any training will be required except for basic instruction in calling the emergency services and keeping the FA Kit stocked etc.

Changes – Training Providers.

HSE approved training providers will automatically be approved to run the EFAW 1 day course and the FAW course.

Non HSE approved training providers wishing to run the EFAW course have two/three options:

1. To become HSE approved and also run a minimum of 6 FAW courses per year
2. Use a QCA Awarding Body, become approved by them and run their EFAW course. An initial approval payment and a payment per certificate will be charged by the Awarding Body.
3. To come under the control of an existing HSE approved training provider as a ‘franchisee’.

Note:

In-house occupational health professionals can provide annual refresher training. HPC registered Paramedics will be exempt from requiring a FAW qualification to carry out training and assessing. They still require experience / qualifications in FA training and assessing.

Guidance to the Approved Code of Practice. – Changes

The HSE are issuing further guidance as to the requirements for first aid provision in the workplace. The above training changes result in two levels of first aider, this in turn will enable a closer match of first aid provision to the needs of the workplace. Although the HSE has produced draft guidance, on this matching process, this is likely to change and hence is excluded from this bulletin. Further information to follow.

Implementation Date.

The HSE has recently announced an implementation date of October 2009. However, minor changes are likely to be introduced later this year.

HSE Consultation Documents for download and reference.

• http://www.FirstAidCafe.co.uk/HSE1107/FAW_ACoP_ GuidanceDraft.doc
• http://www.FirstAidCafe.co.uk/HSE1107/GuidanceFAWtrainingProvidersDraft.doc
• http://www.hse.gov.uk/firstaid/program.htm
• See also http://www.FirstAidCafe.co.uk/Forum/

First Aid at Work – Certificate extensions

The HSE has changed their policy regarding attendance on FAW requalification courses where a students certificate has expired.

A first aider can attend an FAw requalification course up to 3 months before the expiry date on their certificate. Where this has not been possible HSE will allow an extension of the certificate for 28 days beyond the expiry date, and the requalification course should be completed within this time.

There is no need to contact the HSE to request the extension. Any first aider who is unable to complete the requalification course up to a maximum of 28 days after the expiry date, will be required to retake a full FAW course anyone requalifying within the period of certification extension shouldhave their new certificate dated from the expiry date of the previous one.

More information;

www.hse.gov.uk

FIRST AID – Proposed changes to FAW & FAW Requalification courses.

HSE Proposed changes to the employers responsibility to provide first-aiders and their training.

The Health and Safety (First Aid) Regulations 1981 are being reviewed by the Health and Safety Executive and where possible the following information takes account of the recommendations for change with regard to the levels and training of first-aiders, which are due to be implemented in early 2006.

First Aid provision in the workplace saves lives. It can prevent medical conditions or minor injuries from becoming major ones. It can help employers reduce costs from injury and it is a legal obligation on every single employer to make sure that their employees receive the right first aid care in the workplace.

The legal obligation

Employers have an obligation under the Health and Safety (First Aid) Regulations 1981 and Approved Code of Practice (ACOP L74) to make adequate and appropriate First Aid Provision for their workforce. It is recommended that someone is able to undertake First Aid duties at all times when people are at work.

All employers must, in the absence of first-aiders, nominate an Appointed Person/s to take charge of the first aid arrangements, including looking after the facilities and equipment and calling the emergency services when required. (no training required).

It should be remembered that appointed persons are not first-aiders and so should not attempt to give first aid for which they have not been trained.Where employer’s assessment of first aid needs indicates one or more first-aiders should be available, two first aid training course options will be available either:

• Emergency First Aid – 6 hours (presently Emergency Aid for Appointed Persons)
• First Aid at Work – 24 hours (proposed 18 hours)

When the proposals come into effect, both will be required to attend a annual refresher course.

More information;

www.hse.gov.uk

1st October 2006 – New Fire Safety Legislation On 1st October 2006, new fire safety rules came into force. This new legislation affects all employers, all businesses, the voluntary sector and the self employed. The Regulatory Reform (Fire Safety) Order 2005 is the biggest overhaul of fire legislation in decades replacing over 100 existing pieces of fire-safety legislation.

Under the new law, responsibility for fire safety is placed firmly with the employer. The “Responsible Person” for example, the employer, owner or landlord, must take reasonable steps to reduce the risk from fire. Fire certificates have been abolished and have no legal status. To comply with this new legislation you need to carry out a fire-risk assessment, identify any possible dangers and risks. This risk assessment is very important and forms the main ethos of the new order and must be formally recorded if the Responsible Person employs five or more people.

The fire and rescue authority will use this to ensure that you are compliant. Though local fire and rescue authorities will eventually carry out inspections of all premises they have indicated that high life risk premises and in particular where sleeping accommodation is provided will be their priority. The government has developed a set of fire safety risk assessment guides to tell you what you have to do to comply with fire safety law, help you carry out a fire risk assessment and identify the general fire precautions you need to have in place. They can be accessed at www.communities.gov.uk/fire