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OPITO Medical Emergency Response Requirements

OPITO Medical Emergency Response Requirements

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Page 1: OPITO Medical Emergency Response Requirements

OPITO Medical Emergency Response Requirements

Page 2: OPITO Medical Emergency Response Requirements

OPITO Medical Emergency Response Requirements

© OPITO

Revision 0 (January 2016) Page 2 of 20

The content of this document was developed and reviewed in 2015 by OPITO to improve Emergency Response Arrangements based on accepted industry best practices. Guidance on this document is available by contacting OPITO at: Standards enquiries © OPITO All rights reserved. No part of this publication may be reproduced, stored in a retrieval or information storage system, or transmitted, in any form or by any means, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.

AMENDMENTS

AMENDMENT & DATE PAGES CHANGES MADE BY

CHECKED BY APPROVED BY

Revision 0 released January 2016

Melissa Foo Industry and OPITO Approvals Department

Peter Lammiman

Any amendments made to this document by OPITO will be recorded above.

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OPITO Medical Emergency Response Requirements

© OPITO

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CONTENTS

INTRODUCTION ...................................................................................................................................... 4

A.1 MEDICAL EMERGENCY RESPONSE REQUIREMENTS HIERARCHY ............................................................... 5 A.2 MEDICAL EMERGENCY RESPONSE PEOPLE AND COMPETENCE ................................................................ 5 A.3 TIER 0: ALL STAFF ......................................................................................................................... 5

A.3.1 Tier 1: Designated First Aider (DFA) .................................................................................. 6 A.3.2 Tier 2: On-site MER Professional ....................................................................................... 7

A.4 MEDICAL EQUIPMENT, SUPPLIES AND FACILITIES ................................................................................. 8 A.4.1 Tier 1: First Aid Equipment ................................................................................................ 9 A.4.2 Tier 2: MER Equipment ....................................................................................................10

A.5 MER MITIGATING MEASURES........................................................................................................11 A.6 ASSURANCE AND MAINTAINING EMERGENCY RESPONSE PREPAREDNESS .................................................11 A.7 MINDSET AND CULTURE................................................................................................................12

APPENDIX A: EXAMPLE OF AN MER PLAN ..............................................................................................13

APPENDIX B: MEDICAL EMERGENCY RESOURCE REQUIREMENTS GUIDANCE ........................................14

APPENDIX C: EXAMPLE MEDICAL EMERGENCY GAP ANALYSIS TOOL .....................................................15

APPENDIX D: EXAMPLE MER RISK ASSESSMENT TOOL ..........................................................................16

APPENDIX E: SAMPLE MEDICAL SCREENING AND SELF-DECLARATION OF FITNESS FOR ATTENDING OPITO …… TRAINING FORM ...................................................................................................................17

APPENDIX F: INCIDENT DEFINITIONS .....................................................................................................20

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INTRODUCTION

The safety and wellbeing of all delegates undergoing training is paramount and OPITO’s number one priority at all times. This document has been developed in consultation with subject matter experts to provide clear Medical Emergency Response (MER) expectations and requirements for OPITO Approved Training/Assessment Centres to ensure adequate provisions can be made, exercised, recorded, maintained and audited. The medical emergency response requirements set out in this document is derived from industry’s best practices and is based on a tiered time-based response. It details expectations on maximum response times, minimum equipment levels and access to specified medical personnel and facilities in an event of a medical emergency. It also identifies roles, designations, responsibilities and competence of medical emergency response staff. All highlighted area’s indicate OPITO audit requirements, these requirements will be used by OPITO auditors during audit of training providers. Risk Assessment Factors that may have a direct impact on the likelihood and severity of injury or illness, as well as the level of MER resources needed on site are determined by the nature of work activities performed at the site, the number of people on site, transportation options, availability and infrastructure, geography, climate, security, characteristics of the working population (e.g. age profile, gender mix, migrant status, etc), local health facilities’ capability and location. Certain training activities can be arduous by nature requiring high levels of physical exertion and may sometimes induce mental stress on the individual. Not all exercises are without risk (for example, swimming pool and firefighting practical exercises). Some examples of risks associated with training activities may include the risk of a cardiac event or stroke due to physical exertion, drowning, burns and trauma due to injury, slips, trips and falls. Prevention A critical first barrier in the prevention of incidents is to ensure care for delegate’s wellbeing. Delegates must be made aware of the physical nature of this training; it must be ensured that relevant fitness to work, associated with in-company roles and/or fitness to train assessments are required to be up to date at the time of training. Information covering the pre-course requirements for OPITO training is covered in number of OPITO documents, these include sections within the Approval Guide, e.g. criteria 4.1 (joining instructions), section in OPITO standards e.g. A.3 Physical and Stressful Demands and D.1 Joining Instructions within the relevant OPITO standards – Appendix E contains non exhaustive advice to ensure medical screening forms provided by OPITO Approved Training/Assessment Centres are consistent.

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A.1 Medical Emergency Response Requirements Hierarchy

A Medical Emergency Response Plan (Appendix A) sets the expectation of the actions that will take place in response to emergencies, and will be based on the Training Providers site risk assessment. A tiered time-based response (Table 1) forms a suitable basis for MER response at Training Provider sites. Appendix A, B, C and D may be used as an aide to make risk based site specific MER Plans.

Tier Time-based response Matrix

Tier 0

Tier 1

Initiation of intervention – call for help

Provide first aid treatment including, Basic Life Support (BLS), defibrillation and oxygen by a designated (and competent) first aider within 4 minutes.

Tier 2 Provide assessment and stabilisation by a registered MER Professional within 1 hour (within 20 minutes if high risk activity is indicated)*.

Tier 3 Provide admission to and care at the nearest Hospital Emergency Room within 4 hours (within 1 hour if high risk activity is indicated)*. This includes adequate means of transportation by ambulance with competent staff (Tier 2 level) and equipment.

Table 1. MER Tier based response time table

*High Risk activity includes all practical activities covering any practical exercises where there is a risk of serious injury including all in and on water and practical firefighting course elements. Based on the Training Centre and training locations e.g. the geographical location may impact on the risk assessment therefore the tiered requirement would be extended to other standards e.g. Competence Assessor, H2S, Rigging and Slinging. Audit Requirement – MER A.1 Tier Time based responses are indicated in the risk assessments as per the matrix

A.2 Medical Emergency Response People and Competence

The Training Centre shall develop an annual training matrix/plan for all individuals involved in incident management and Medical Emergency Response, this plan maybe be part of other training plans for individuals, the plan will identify all required training and necessary (refresher) training. The completion of the trainings and the necessary competency certifications will be maintained on record. Audit Requirement – MER A.2 Annual Training Matrix/Plans are current and available for all relevant MER staff, this may be included in the Training Providers overall training plan.

A.3 Tier 0: All staff

Tier 0 includes all training centre staff. Review of incidents has shown that failures in first response can cause significant delay. It is known that to be effective first aid and defibrillation has to be delivered as quickly as possible. An important step to achieving an effective response is to ensure everyone knows

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what to deal with an emergency. Tier 0 training can take place at site induction, and training records are to be maintained to demonstrate that Tier 0 training has taken place and refreshed as required, Tier 0 training would include the following: Frequently mnemonics are to be used to assist in memorising the type of information that may need be passed internally or externally and may include but not be limited to the following: a) How to raise the Alarm, Scene Safety, site location which can include the availability of GPS co-

ordinates b) Nature of incident/emergency c) Casualty assessment (TRIAGE – basic initial diagnosis) basic dos and don’ts, assure/reassure

comfort, care of casualty, keep warm/shade, do not move etc. d) Site specific hazards (Fire, Chemicals, etc.) e) Access Routes (e.g. specify which gate to use if multiple entrances and notify security) f) Number of Casualties, action taken g) Recognition of stress in delegates h) Type of Emergency services already present or required Some basic first aid e.g. the First Aid section of the BOSIET standard is also recommended for training provider staff. Audit Requirement – A.3 Staff training covering Tier 0 (A.3 a – h) has been conducted, training records are available and current.

A.3.1 Tier 1: Designated First Aider (DFA)

Designated First aiders are the first MER team member providing support at a scene of an incident. DFA training must include the following: a) Scene assessment and safety b) Life Support to include CPR and AED c) Airway management (head tilt, chin lift) d) Basic First Aid Management (of burns and minor injuries) e) Initial treatment of common medical emergencies f) Administering O2 using appropriate O2 equipment

In order to avoid DFA competence decay, DFA competence is to be maintained through ongoing skills maintenance training. These are commonly implemented on 3-monthly cycles by informal practical training sessions at the workplace, and facilitated by a Tier 2 MER Professional. Each session would generally last about 2-3 hours. A listing of approved DFA courses can be found on most National Health and Safety Authority websites, good examples of approved DFA courses are Red Cross/Red Crescent/St. John Ambulance/American Heart Association. Audit Requirement - A.3.1.1 Designated First Aiders (DFA) hold valid DFA qualification as listed on National websites, or qualified with Red Cross/Red Crescent/St John Ambulance/American Heart Foundation, in addition there is evidence that items A3.1 a – f have been covered.

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Audit Requirement - A.3.1.2 Records of Informal practical training sessions is conducted at the workplace facilitated by a Tier 2 MER Professional on a 3 monthly cycle.

A.3.2 Tier 2: On-site MER Professional

Although the stated response time for Tier 2 is 1 hour, if the course programme includes activities with a High Risk of serious injury, the required Medical response time would be reduced to 20 minutes as per Tier Time based response matrix and may require Tier 2 MER staff, equipment and facilities on site. Tier 2 MER Professionals are registered nurses, emergency medical technicians, paramedics, nurse practitioners, physician assistants or physicians. They are responsible for providing assessment and stabilisation of ill or injured persons. 1) Tier 2 MER Professional Capabilities

A Tier 2 Medical Professional is at minimum expected to recognize, assess and stabilize a patient

showing signs of cardiac arrest, stroke, drowning, burns and trauma, and be proficient in the following:

a) Competence application of CPR and AED usage b) Advanced airway management – insertion of oro/nasopharyngeal airway and bag/mask

ventilation c) Establishing IV/IO access d) Starting IV/IO fluids e) Administering IV/IO adrenaline f) Quick neurological assessment using GCS score g) Treat hypovolemia, hypoxia, hypothermia, tension pneumothorax and pulmonary and

coronary thrombosis

2) All Tier 2 MER Professionals must be in possession of a valid international medical qualification which will include Basic Life Support (BLS) and Advanced Life/Cardiac Support (ALS/ACLS) or equivalent e.g.

a) Pre-Hospital Emergency Care Course (PHECC), b) Pre-Hospital Trauma Life Support (PHTLS) c) Advanced Trauma Life Support (ATLS)

These courses are good examples of courses that include Advanced Life Support training. Audit Requirement – A.3.2.1 MER Professionals are in possession of a valid international medical qualification which includes Basic Life Support (BLS) and Advanced Life/Cardiac Support (ALS/ACLS) or equivalent. 3) There must be medical protocols for the training centre Tier 2 Medical Professionals to use (as a

minimum protocols covering drowning, cardiac arrest, respiratory arrest, burns and other serious injury scenarios as identified in training provider risk assessment), these protocols must be supervised and audited by a supervising medical professional e.g. a Doctor yearly, aid memoir - posters would be available to act as prompts when dealing with situations requiring specific protocol

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response. All Tier 2 Medical Emergency professionals will have access to a senior supervising medical professional e.g. a doctor for case advice and discussion at all times when training/assessment is taking place. (See MER mitigation measures (section 5)

Audit Requirement – A.3.2.2 Medical Protocols are available for Tier 2 Medical Professionals covering applicable serious injury scenario’s as identified in training provider risk assessment Audit Requirement – A.3.2.3 Yearly protocol audit records from the Supervising Professional e.g. a Doctor are available and current Audit Requirement – A.3.2.4 MER Tier 2 Medical Professionals have access to supervising medical doctor during training. 4) Skills Maintenance of Tier 2 MER Professional:

In addition to renewal of Certification (generally valid for 3 years), a 6 -12 week hands-on training/refresher in an ambulance/emergency room, trauma unit or similar setting would be required, unless skills maintenance have been maintained on a continual basis (e.g. MER Professional works part-time in one the aforementioned settings).

Tier 2 MER Professional Refresher Training Components and Skills will include:

a) Basic Life Support skills b) Recognition, assessment, stabilisation and management of the deteriorating patient using a

structured ABCDE* approach c) Advanced Airway management skills (use of oro/naso pharyngeal airway to ventilate/oxygenate) d) Cardiac and Respiratory arrest management (including IV/IO access, medication, ECG)

*ABCDE – Airway, Breathing, Circulation, Disability, Exposure Audit Requirement – A.3.2.5 Tier 2 MER Professional certification is available and current, and is maintained as indicated in section A.3.2 (4)

A.4 Medical Equipment, Supplies and Facilities

There will be sufficient suitable medical equipment available at all points of use as identified in the risk assessment e.g. all high risk areas – practical firefighting sites, and practical water based activities (refer Appendix C). The equipment shall be inspected and maintained in predetermined intervals to ensure correction functioning at the point of use. The intervals will meet, as a minimum, the respective manufacturer specifications and be operated and used in the respective regular drill exercises. Audit Requirement – A.4.1 The Risk Assessment shall identify the location, type and quantity of medical equipment available.

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Audit Requirement – A.4.2 The medical equipment is maintained as per manufacturers specification, maintenance records are available. A current site layout, which will include as a minimum the location of all emergency response equipment appropriate to the risks identified in the risk assessments e.g. O2 administration and AED equipment is located next to high risk areas e.g. a pool side, the layout will be explained and be visible to delegates. Audit Requirement – A.4.3 The training site layout includes the locations of emergency response equipment, the layout is explained and visible to delegates at the training location. Proximity to the nearest hospital emergency room is an important factor to consider in medical emergency response planning, as this will influence the level of training and competence required by medical emergency response staff, as per matrix contained within section A.1 Training Provider facilities must ensure: 1) There is an adequate external Tier 3 facility (Hospital Emergency Room) which can meet the Tier 2

response time, this includes adequate means of transportation (competent ambulance staff, equipment and capabilities).

2) In the absence of suitable external Tier 3 facilities within the Tier 2 response time, Training Providers must provide their own, competent Tier 2 MER Professionals, transportation and equipment.

Audit Requirement – A.4.4 Training Providers have suitable external Tier 3 facilities within the Tier 2 response time. Audit Requirement – A.4.5 Competent Tier 2 MER Professionals, transportation and equipment are available where Tier 3 facilities are not available onsite, to ensure delegate wellbeing enroute to Tier 3 facilities.

A.4.1 Tier 1: First Aid Equipment

First Aid Equipment is inspected and maintained, the maintenance is carried out by an individual or company authorised and competent to conduct the maintenance. First Aid equipment is managed and used by Designated First Aiders (DFA). Equipment must include the following:

First Aid Equipment a) Automated external defibrillator (AED) b) Barrier devices and protection (i.e. pocket mask, rubber gloves, protective goggles, plastic apron,

biohazard waste bag) c) Vital signs equipment (i.e. automatic blood pressure measurement device, digital thermometer) d) Bandages (i.e. triangular, elastic, roller). e) Dressings (i.e. gauze pads, burn dressings, multi-trauma dressings, eye pads, antiseptic wash, adhesive

dressings) f) Foil blanket (adult size)

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g) Splints (e.g. SAM splints) h) Cold pack compress i) Miscellaneous: adhesive tape, cotton buds, safety pins, pen, paper, scissors j) Guides: Basic life support (BLS) algorithm card, first aid pocketbook k) Inventory of box contents l) Oxygen

Audit Requirement – A.4.1.1 Sufficient First Aid Equipment is available and includes items listed A.4.1 a – l

A.4.2 Tier 2: MER Equipment

MER Equipment is inspected and maintained, the maintenance is carried out by an individual authorised and competent to conduct the maintenance. MER equipment is managed and used by Tier 2 MER Professional and must include the following:

Tier 2 Medical Equipment

a) First Aid bag (see contents list above) b) Laryngeal mask or similar c) Oro and nasopharyngeal airways d) IV cannulas e) IO cannulas f) Infusion sets and saline g) Medication for pain relief, resuscitation h) Suction device i) 12 lead ECG j) The non-invasive blood pressure (NIBP) monitoring system k) Monitoring system for Oxygen saturation - SaO2 l) Blood sugar measurement m) Pupil torch n) Current Medical Protocols

Audit Requirement – A.4.2.1 Sufficient Medical Equipment is available and includes items listed A.4.2 a – n Additional equipment and supplies (based on the training provider risk assessment) may be needed for specific hazards or specific environments, these may include diving operations. In addition, for Tier 1 a ‘designated room’ or Tier 2 ‘designated medical room’ is required to enable stabilization prior transportation to hospital, or stabilization on site prior to re-joining training, Audit Requirement – A.4.2.2 A suitable ‘designated room’ or ‘designated medical room’ is available during training activities The link to the type of medical material like protocols for staff to use can be found here: https://www.acls.net/aclsalg.htm. This is to ensure that personnel have access to current medical protocols, for example on managing stroke, cardiac and respiratory arrest. Protocols from other

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equivalent internationally recognised organisations are acceptable. equivalent internationally recognised organisations are acceptable.

A.5 MER Mitigating Measures

The following are examples of suitable additional mitigation measures to ensure that MER risks are kept as low as reasonably practicable in particular these measures would be applied in more remote locations, these measures are provided to assist training providers in identifying the most effective risk mitigation options, it is expected these options would be incorporated into risk assessments where applicable:

Risk Mitigation Measures

1. Additional MER Staff resources and capability

a) Enhance Tier 1 and Tier 2 competency by specifying higher requirements for skills and experience e.g. Oxygen Administration for DFAs.

b) Specify that all Tier 2 MER Professionals will be proficient in managing risks identified in the site risk assessment (e.g. risk of cardiac arrest, stroke, drowning, burns, trauma, heat exhaustions etc.)

c) Increase number of Tier 2 MER Professionals d) Shortening of Tier response times

2. Equipment/Supplies

a) Additional medical equipment and supplies, in order to enhance the Training Facilities ability to manage challenging cases on-site (e.g. ECG)

3. Support and Telemedicine

a) Implement a system for the site Tier 2 MER professional to access real-time specialist medical advice and instruction from emergency senior medical professionals (usually doctors) located at the nearest emergency room facility, via telecommunications and/or information technologies. For further info see the IRHC Guide (Institute for Remote Healthcare Guide).

4. Improved transportation a) Put transportation on standby (e.g. Locate standby ambulance onsite)

b) Use faster transportation (e.g. air transportation instead of ground transport)

A.6 Assurance and Maintaining Emergency Response Preparedness

The organisation’s Medical Emergency Response Plans and Procedures, shall be reviewed every three years and approved annually for accuracy, The MER plan will form the basis for regular effectiveness testing and scenario drills. The training provider will establish, maintain and execute a programme of exercises that tests their plans, procedures and scenarios.

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Audit Requirement A.6.1 – Medical Emergency Response Plans are reviewed every three years, and approved annually Realistic MER Tier 1 drills are to be conducted as a minimum quarterly. Where applicable, in and on water based activities Tier 1 drills are to include practicing casualty extraction, First Aid/BLS provision, basic oxygen therapy, CPR and defibrillator administration. Realistic Tier 2 drills of the Medical Emergency Response protocols will be carried out twice per year, and annually extended to include third party emergency services (such as ambulance and the nearest Tier 3 facility) to verify ongoing effectiveness. All records of emergency response drills and exercises are to be maintained, In general, each emergency effectiveness practice exercise would include the following;

a) Test a particular emergency response scenario and be measured for its effectiveness b) Include the testing of notification and implementation of relevant procedures c) Test the internal emergency response team communications and communications between

internal and external response services d) Record those personnel involved e) Record the emergency and medical equipment used f) Ensure the chronology of events and was recorded including actual response times g) Contain a conclusion in relation to the effectiveness of the response and include lessons learned.

It is expected that any resultant learning will be applied to the relevant Emergency Response Plans and documents.

Audit Requirement A.6.2 – Records are maintained of quarterly MER Tier 1 drills as per requirements contained within A.6. Where applicable, practicing casualty extraction, First Aid/BLS administration, basic oxygen therapy, CPR and defibrillator administration are to be included Audit Requirement A.6.3 - Records are maintained of bi annual MER Tier 2 drills as per requirements contained within A.6.

Audit Requirement A.6.4 - Records are maintained of annual MER Tier 2 drills including Tier 3 third party emergency services as per requirements contained within A.6.

A.7 Mindset and Culture

Worksite cultures vary and demonstrating a strong Health and Safety mind-set is paramount to achieving a safe and healthy outcome. Medical Protocols, and Right and Duty to Stop Messaging e.g. posters will be clearly visible to all at the Training/Assessment Centre. Trainers will be aware of training centre specific hazards and health and safety risks. All trainers and medical emergency responders will be able to identify unsafe conditions or the first signs of stress/distress and will be empowered to intervene without hesitation at all times. Under no circumstances should training commence without appropriate medical emergency response capability being available onsite

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APPENDIX A: Example of an MER Plan

Assess scene and casualty

Make the area safe

Notify Site Emergency Coordination Centre (ECC)

Notify:

Incident location

Number of personnel injured

Nature of injury/illness

Incident contained or escalating

Obtain first aid bag (with AED)

Assess casualty

Provide Basic Life Support (BLS) / First Aid/Oxygen

Activate Tier 2

Notify Site Emergency Coordination Centre (ECC)

Dispatch Tier 2 Medical Professional

Obtain Trauma Bag and Spinal Board

Mobilise to incident site

Assess casualty

Provide Advanced Life Support

Transfer to Designated Room

Contact Site Emergency Coordination Centre (ECC)

Medevac to Tier 3 required?

Activate Medevac

Notify Site Emergency Coordination Centre (ECC)

Notify Hospital: 888-888-888

Confirm casualty arrived at Tier 3 Hospital

De-escalate

Monitor progress

Incident occurs

Treat casualty on-site

Notify ECC: De-escalate

Notify:

Provisional diagnosis and severity

Treatment given

Transportation and route

Contact number of medical escort

Medical support during transport

Bystander

ECC

DFA

Medical Professional

Medical Professional

Tie

r 0

: Im

me

dia

te

Tie

r 1

: <

4 m

inu

tes

Tie

r 2

: <

1 h

ou

r *

Tie

r 3:<

4 h

ou

rs

Notify and Dispatch Designated First Aiders

ECC

Treat casualty on-site designated room

Notify ECC: De-escalate

Tier 2 activation required?

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APPENDIX B: Medical Emergency Resource Requirements guidance

Tier By At

Time (after incident)

Equipment/ Transport

requirements

Training requirements

Skills maintenance requirements

Tier 0 (Initiation) Bystander Site Immediate - • Call for help • Make area safe • Do’s and don’ts (usually one hour on induction, for everyone on site)

• Every 1-2 years

Tier 1 (First aid and Defibrillation)

Designated First Aider (DFA)

Site <4 minutes • First aid bag • Automated

External Defibrillator (AED)

• Oxygen

• DFA Training (usually 40 hours)

• DFA skills refresher (Usually every 3 months, for 2 hours)

Tier 2 (Medical stabilisation)

Medical professional (Medic /Nurse /Doctor)

Designated room

<1 hour (or 20 mins depending on risk assessment)

• Trauma Bag • Ambulance, and

ambulance equipment

• Designated room equipment and supplies

• Professional medical training

• Advanced Life Support (ALS/ACLS) training

• ALS/ACLS training every 3 years

Tier 3 (Hospital admission and care)

Emergency physician

Hospital <4 hours • Ground, sea or air transportation

- -

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APPENDIX C: Example Medical Emergency Gap Analysis Tool

Response Comments Is there

a gap?

Risk

1. How many people are training/working at the site at any given time?

2. What is the nature of the training/work performed at the facility?

3. What are the main hazards at the facility?

4. Based on incident records from the past 5 years

a. How many injuries/illness have occurred?

b. What were the commonest injuries/illness? Tier 0: First Response by Bystander (Immediate)

5. Do all bystanders (all staff and contractors) know how to:

a. Initiate MER (call for help)?

b. Make the area safe?

c. Observe Do’s and Don’ts

Tier 1: First Aid and Defibrillation by a Designated First Aider (4 minutes)

6. Is First Aid and Defibrillation by a Designated First Aider (DFA) available within 4 minutes?

7. Are there enough trained DFAs to cover a 4-minute response time for all areas on site?

8. Has the DFA training been assessed for its adequacy?

9. Does the DFA training meet the DFA training requirements?

10. How are the training documentation recorded and maintained? 11. Are DFA Skills adequately maintained through a skills maintenance

program (e.g. regular refresher training)?

12. How many First Aid Boxes are on site?

13. Where are the First Aid Boxes located?

14. Are the First Aid Boxes

a. Placed at accessible locations?

b. Visible? c. Adequately protected from the elements?

15. Based on the First Aid Boxes’ quantities and locations, can it be brought by the DFA to all areas on site within 4 minutes?

16. Is there an identified person (e.g. DFA) responsible for maintaining and checking each First Aid Box?

17. How many automated external defibrillators (AED) are on location? 18. Where are the defibrillators located?

19. Are the AED’s:

a. Placed at accessible locations?

b. Visible?

c. Adequately protected from the elements?

20. Based on the AED quantities and locations, can the AED’s be taken by the DFA to all areas on site within 4 minutes?

21. Is there an identified person (e.g. DFA) responsible for maintaining and checking each AED?

Tier 2: Assessment and stabilisation by a medical Emergency professional (1 hour)

22. Is an assessment and stabilisation by a Medical professional available within one hour (<20 mins for high risk facilities)?

23. Has the medical professional completed training in Advanced Life Support (or equivalent)?

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24. Is the medical professional’s equipment (e.g. Trauma Bag) adequate in providing professional assessment and stabilisation?

25. If an ambulance is used, has it been assessed for its safety?

26. Are the ambulance and its equipment adequate in providing professional assessment and stabilisation?

27. If a Site Clinic is used, has the Site Clinic been adequately assessed

28. Is the Site Clinic equipment adequate in providing professional assessment and stabilisation?

Tier 3 (Admission to and care at the nearest Local Hospital within 4 hours)

29. Can admission at the nearest Local Hospital within 4 hours be achieved at all times?

30. Have the patient transportation (e.g. ambulance) been assessed (for their adequacy to be included in the MER Plan)?

APPENDIX D: Example MER Gap Assessment Tool

Requirement Met?

(Yes/No) Gap Reasons for

Gap Potential Impact Risk

Rating Mitigations

First Aid by a DFA within 4 minutes

e.g. No (e.g. not enough DFA numbers)

(e.g. no training facility available)

e.g. delayed CPR leading to irreversible injury or death.

-

Defibrillation by a DFA within 4 minutes

e.g. No (e.g. Not enough defibrillators)

(e.g. cost) e.g. inability to defibrillate results in death

-

Assessment and stabilisation by a medical emergency professional within 1 hour (<20 mins depending on risk)

Admission to and care at the nearest Local hospital within 4 hours

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APPENDIX E: Sample Medical Screening and Self-Declaration of Fitness for Attending OPITO ……

Training Form

Course Title Course Dates

Full Name Phone Number

Date of Birth

Company

Emergency Contact Name

Contact’s Phone number

1. Please read the following carefully:

Physical activities associated with this training course may include, but are not limited to:

Moving through the water using your arms while wearing a life jacket and/transit or immersion suit.

Holding your breath to egress underwater in a helicopter simulator module.

Entering the water from pool side or at height 3.3ft or 1m.

Towing other persons in the water.

Pulling action on the upper body when climbing in or out of the pool.

Pulling action on the upper body when pulling yourself up and into a life raft from the water. (Similar to doing a chin-up but with an additional 20 lbs/10kg of weight added to your body.) Extensive use of joints – shoulders, neck, elbows, wrists, hips, knees.

Twisting and torquing the upper body.

Breathing from emergency breathing devices.

Sitting in a classroom environment for at least 50 consecutive minutes.

Crawling over/under objects in low visibility situations

2. Delegate Medical Self Declaration

The following questionnaire is provided for your personal review. If you have any of the following medical conditions or answer yes to any of the questions you are advised to:

Provide the list of training requirements to your physician Consult with your Physician to determine if you are fit to safely complete the training

This medical questionnaire may be voluntarily used by the delegate to discuss whether they are physically able to participate in course(s). This list of questions is by no means an exhaustive list of all questions you should discuss with your medical provider. Instead, it is being provided to you as guidance of what questions you may want to discuss with your medical provider prior to signing your Training Participant Medical Declaration acknowledging your fitness to participate in the training programme.

Questions Yes No If Yes, What and When?

Have you ever been hospitalized or been under a surgical intervention recently?

Do you have any physical disability?

Do you wear prescription glasses or contacts?

Are you presently on light duty because of a medical condition?

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Did you have any disease, altered state of health or any accident in past 12 months?

Have you been treated or being in the care of a doctor in the last 12 months for any medical condition that would require a doctor’s release?

Do you have any phobias such as Height, Enclosed Spaces, Water, etc.

Are you suffering from any physical or physiological condition not mentioned that could affect your participation in any of the training physical activities?

Do you have any anxiety that could prevent you from safely completing this training?

Have you ever had epilepsy/ seizures / fainting / “blackout”?

Have you ever had a head injury?

Do you have any problems with headaches / balance / hearing?

Do you have trouble with swimming?

Are you a limited or non-swimmer?

Are your ears sensitive to water? Have you had previous ear issues while swimming or after swimming?

Do you have shortness of breath/breathing difficulties?

Have you suffered chest pains?

Do you have a history of displaced joints (bad knee, bad back etc.)

Are you allergic to any medicine/substance?

Are you pregnant? If Yes, How long have you been pregnant? Are you currently under any treatment or any kind of medication?

Have you taken any medication in the past 24 hours that could impair your ability during this training?

Do you suffer or have you suffered from?

RESPIRATORY Diseases (allergies, asthma, bronchitis, tuberculosis or other)

CARDIOVASCULAR diseases (heart attack, angina, thrombosis, phlebitis or other)

DIGESTIVE SYSTEM Diseases (gastritis, ulcers, hepatitis B/C or other diseases)

URINARY SYSTEM Diseases (infection, kidney stones or other)

METABOLIC Diseases (diabetes, obesity, anemia or other)

BONE SYSTEM Diseases (arthritis, bone fracture, dislocation, slipped disc, rheumatism or other)

NEUROLOGICAL Diseases (epilepsy, depression or other)

SKIN diseases (ringworm, folliculitis, herpes or other)

EYES Diseases (myopia or other)

High blood pressure

VARICOSE veins (poor circulation, and phlebitis)

Hernias, Hemorrhoids or Fistulas

Please list any other medical problems or recent injuries that may limit your ability to safely complete this training.

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I understand that all the above information that I have supplied will be kept “most confidential” unless issues arise regarding my health and safety. Should an incident occur, I agree that any information needed to aid in my care can be released.

I have read the above and declare that all information provided on this form is accurate and that I have not withheld any information regarding the status of my health.

I am aware that the occurrence of any accident or illness in training must be immediately reported to the instructor or the responsible health professional.

Delegate to declare that he/she is fit to attend the course at the start of each training day.

TRAINING DAY 1 Delegate’s Signature

Date

TRAINING DAY 2 Delegate’s Signature

Date

TRAINING DAY 3 Delegate’s Signature

Date

Post Training Attestation At the end of all practical training, the delegate must sign this form in the table below, stating whether or not there was some type of injury sustained during training, if so; the delegate should be directed to receive medical care in order to receive assistance.

I have attended the scheduled training at the Training Centre.

I am departing the Training Centre and declare I experienced no medical issues or incidents.

If I did experience an incident I reported it to the proper personnel and am satisfied with the outcome and/or how the incident is being managed.

I have completed the training incident free.

To the best of my knowledge, I did not sustain any medical related condition or experience any incident in connection with the training I participated in which could cause medical problems.

I declare the above statements to be true to the best of my knowledge.

In the event that I feel I need medical attention after the class (later that evening, the next day, etc) I understand I must coordinate this through my company via my supervisor or other authorized company representative

Delegate’s Signature:

Date:

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Incident occurred, YES/NO? If Yes, please provide a full description:

APPENDIX F: Incident Definitions

Fatality (FAT): A death resulting from a work related injury or occupational illness Permanent Total Disability (PTD): Any work related injury that permanently incapacitates Lost Workday Case (LWC): Any work related injury that renders the injured person temporarily unable to perform their normal work restricted work on any day after the day on which the injury occurred Restricted Work Case (RWC): Any work related injury which renders the injured person temporarily unable to perform all, but still some, of their normal work on any day after the day on which the injury occurred. Medical Treatment Case (MTC): Any work related injury that involves neither lost workdays nor restricted workdays, but which requires treatment by a physician or other medical specialist. First Aid Case (FAC): Any single treatment and subsequent observation of minor scratches, cuts, burns, splinters, etc. that do not normally require medical care by a physician. Such treatment and observation is considered first aid case even if provided by a physician or registered professional personnel. Lost Time Incidents (LTI): The sum of injuries resulting in fatalities, permanent total disabilities and lost workday cases, but excluding restricted work cases, medical treatment cases and first aid cases. LTI = FAT or PTD or LWC.