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Lesson 9: MEDICAL ISSUES

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Lesson 9: MEDICAL ISSUES Confined Space Lesson 9: MEDICAL ISSUES INSTRUCTIONAL GOAL Upon completion of this topic, the student will understand that everyone associated with confined space operations should have a basic understanding of the types of medical emergencies they may encounter. ENABLING OBJECTIVES Based on the information presented in the classroom and in the student guide, the student will be able to: 1. Identify the types of injuries that may occur during confined space entry operations. 2. Identify environmental conditions that could cause heat-related illnesses. 3. Identify the signs and symptoms of heat stress, heat exhaustion, and heat stroke. 4. Summarize the responsibilities of the attendant in the event of a medical emergency within a confined space. OVERVIEW It is necessary that attendants and entrants can recognize potential problems, be able to activate emergency medical services in their plant or municipality, and provide first aid until the arrival of medically trained personnel. ≤HMTRI 2004 Page 69 Confined Space 0edical Issues Everyone associated with confined space operations should have a basic understanding of the types of medical emergencies that they may encounter. To effectively do this, it is necessary to recognize potential problems, be able to activate emergency medical services in your plant or municipality, and provide first aid until the arrival of medically trained personnel. OSHA recognizes the need for some level of medical awareness. They have mandated that all individuals associated with the confined space entry and/or rescue be trained in CPR and basic first aid. At least one individual with current certification shall be available during rescue operations. All individuals associated with confined space operations also need to know the location and operation of emergency medical supplies and equipment. It is the attendant's job to summon emergency medical assistance in the event of a medical problem. If an entrant has a serious medical problem, the entire space should be evacuated immediately. Any medical affliction that occurs within the space should be assumed to have been caused by a change in the confined space until proven otherwise. If an injured entrant is exposed to a substance, the MSDS or other written information must be made available to the medical facility treating the exposed entrant. Additional medical concerns include heart attack, asphyxia, chemical toxicity, heat stroke, burns, fractures, and lacerations. Although these considerations are important, extrication of the victim from the confined space should be implemented prior to the administration of basic first aid. Heart Attack Characterized usually by chest pain, shortness of breath, nausea, and weakness, heart attack is one of the greatest medical killers of industrial and municipal workers. Usually the onset of severe chest pain is fairly rapid, but any chest pain should be cause for concern. Appropriate treatment would include immediate removal from the confined space and early activation of emergency medical services. If cardiac arrest occurs, cardio pulmonary resuscitation (CPR) and cardiac defibrillation may be performed inside or outside the space. Early external defibrillation should not be delayed because of concerns about the conductivity of metal or wet surfaces. According to the American Heart Association (Guidelines 2000), metal surfaces —pose no hazard to the victim or the rescuer.“ ≤HMTRI 2004 Page 70 Confined Space Asphyxia Asphyxia occurs when the body is deprived of oxygen. Engulfment or entering oxygen deficient atmospheres without SCBA are probably the two most common causes of asphyxia. Usually the person is unconscious, cyanotic (blue in color), and not breathing. Initiation of mouth-to-mouth resuscitation and CPR (if the heart has stopped) is critical for the patient's survival. This must not be done while the patient is in the confined space if IDLH conditions are present. Chem ical Toxicity A person who inhales a toxic chemical and suffers acute effects will probably have shortness of breath as the primary symptom. This is especially true if the chemical was an irritant. Chemical asphyxiants usually cause cyanosis and stop the ability to breathe. Regardless of the type of chemical inhaled, removal of the individual from the space is the first priority followed by EMS activation. CPR may be necessary if the victim‘s heart has stopped. Be careful not to contaminate yourself by coming into unprotected contact with the patient. If the chemical was absorbed, removal of clothing and decontamination is necessary. Burns Confined space entrants may suffer everything from a minor burn on the finger to massive, whole body burns from an explosion or flash fire. In minor burns, infection is the primary concern. Ensure that the patient cleans and dresses the burn as soon as possible. Major burns are medical catastrophes and require attention immediately. Removal from the space and EMS activation are initial priorities. Respiratory complications are common for confined space fire victims. Keep the patient warm, but do not put ointments or salves on major burns. Fractures Fractures are common injuries in confined spaces and should be immobilized if conditions within the space permit. If not, evacuation of the patient from the space should proceed as carefully as possible. A patient who has a fracture due to a fall should also be evaluated for other more serious internal injuries. In most cases, fractures of the extremities do not present a life-threatening situation. Lacerations Lacerations give rise to three primary concerns: ñ Blood loss for the victim. ñ Infection of the victim. ñ Possible exposure to contaminated blood by the rescuer. ≤HMTRI 2004 Page 71 Confined Space In most instances, blood loss from lacerations may look severe but in reality is fairly insignificant. Severe arterial bleeding, on the other hand, can be life- threatening. Bleeding can usually be stopped by applying direct pressure. Obviously, initial treatment includes evacuation from the space and prompt EMS notification. The employee who sustains a laceration in a confined space should seek medial attention. The first step to do in any confined space medical emergency is to evacuate the injured person, evacuate other entrants, and notify medical authorities. The entrant is also responsible for informing the attendant or person in charge if he/they will be unable to function because of medical problems and symptoms that they might be experiencing. Heat Stress, Heat Exhaustion, and Heat Stroke In a hot, humid environment such as a confined space, entrants will run the risk of injury due to rising of the core body temperature. Heat sickness can happen quickly and if signs and symptoms relating to heat sickness are ignored, they can lead to coma, irreversible brain damage, or even death. Signs and Symptoms of Heat Stress Body core temperature range 99.5oF to 102oF Confusion and poor judgment Loss of coordination Signs and Symptoms of Heat Exhaustion Body core temperature range 102oF to 105oF Confusion and poor judgment Loss of coordination Decreased level of consciousness Pale, cool, sweaty skin Headache Muscular weakness Dizziness Profuse sweating W eak, rapid pulse Rapid, shallow breathing In severe cases, the body core temperature may rise above 105oF. This type of heat sickness is immediately a life-threatening emergency and requires prompt medical attention. Signs and Symptoms of Heat Stroke Body core temperature range above 105oF Decreased level or loss of consciousness Hot, dry skin Rapid pulse Rapid, shallow breathing Hypotension ≤HMTRI 2004 Page 72 Confined Space Attempt to cool the patient with cool towels as long as this does not delay transport. Rapid transport to the hospital and advanced medical care are vital. Patient Packaging If a victim has sustained injuries from a fall, entrapment, or something dropped upon him, he will need proper packaging. As a rescuer, you will need to assess the situation, stabilize by performing the necessary first aid, package, and remove the victim. All rescuers and attendants need basic first aid and CPR training. W hen preparing an individual for packaging, the ABCs of life saving are checked: Airway open, victim is Breathing, and Circulation (heart beating). Stop any profuse bleeding and apply a C-collar and splint where necessary. If victim injury is due to atmospheric contamination, rapid removal of the victim may take priority over all else. Depending on research sources, over 50 percent of confined space accidents are atmosphere related. Various techniques for victim packaging and removal are utilized depending upon the situation and type of confined space. W ristlets, full body harnesses, and basket litters are the most common types of packaging. W hen using a basket litter, never attach a line to just one point on the rail of the litter. Many basket litters have butt-welds that can fail under a sudden load. A method to rig a litter involves a figure-8 lacing the rope to the litter, then securing with two clove hitches and two square safety knots. This procedure requires an additional 25 to 30 feet of rope. Lashing the Victim W hen lashing a victim in a basket litter, wrap the ankle and foot (if ankle and foot are not injured). Care must be used to not cross the neck and constrict breathing. Using 30 feet of one-inch webbing with clove hitches as safety ties works nicely. Though basket litters usually are supplied with four straps for securing the patient, these are not adequate when making a vertical rescue. Other Medical Considerations Preventative care for individuals who will enter confined spaces is highly recommended. Screening physicals for persons entering confined spaces is also advocated. Immunizations should also be kept up-to-date. ≤HMTRI 2004 Page 73 Confined Space Any type of injury or hazardous material exposure should be documented and evaluated. W orkman's compensation benefits, as well as effective medical care, may be dependent upon the timely completion of necessary forms and reports.
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