March/April 2004
From teaching CPR to making sure employees know the proper way to call 911, safety-focused scrap processors know that good training can make the difference between life and death.
By Robert L. Reid
If an employee, customer, or visitor had a heart attack or suffered a life-threatening injury at your worksite, would you—or anyone else there—know what to do? If so, could you do it quickly enough?
In the worst cases of cardiac arrest—when the heart actually stops—the window of lifesaving opportunity is narrow. “You’ve got four to six minutes—after that, the person’s gone,” says Mike Mattia, ISRI’s director of risk management. “You could be right next to a fire station, and even they couldn’t get there in time.” Even if the person’s heart is restarted after those six minutes, he or she will likely suffer brain damage, notes Mattia, whose background includes five years with a fire department rescue team.
That’s why some safety-focused scrap processors are training their employees in cardiopulmonary resuscitation, the chest-compressing/mouth-to-mouth breathing first-aid technique better known as CPR. Also, these processors are teaching employees what to do—and equally important, what not to do—in other traumatic situations, such as when an arm or leg gets cut off by a piece of equipment or when part of someone’s body is crushed beneath a heavy weight.
It’s the kind of safety training that literally saves lives. Consider these examples:
• Last May, a customer who was unloading scrap at Assad Iron & Metals Inc.’s plant in Brownsville, Pa., suddenly fell over and stopped moving. Gus Soldano, an Assad crane operator, saw the customer collapse and quickly radioed the yard foreman, George Dressel, who called the office to alert 911. While waiting for the paramedics, Soldano and Dressel—both of whom had been trained in emergency first aid—determined that the customer wasn’t breathing and had no pulse. So they began CPR and mouth-to-mouth resuscitation, which soon enabled the customer to breath on his own again, explains Vic Alfieri, Assad’s safety director, who also assisted with the first-aid treatment. The paramedics then arrived, took over, and transferred the customer to the hospital, where he recovered (though he needed a pacemaker and medication). “Later that day,” Alfieri says, “the paramedics called and said that whoever gave that man CPR did a great job.”
• Miller Compressing Co. (Milwaukee, Wis.) is another scrap processor that trains employees in CPR and other emergency first-aid techniques. In a 1999 ReMA Safety Video Newsletter, company personnel described at least two incidents where CPR helped save someone’s life. In the first case, maintenance employee Bill Reik and the company’s safety director Jeff Tamillo responded to a man who’d had a heart attack at the scale. Using CPR, they helped restore the man’s pulse and breathing by the time the paramedics arrived. In the other incident, another maintenance worker named Kenneth Obarski administered lifesaving CPR to a fellow employee who had accidentally touched a live electrical line. Obarski’s quick action saved the man’s life, and Miller Compressing installed new safety guards to prevent a reoccurrence.
• Various scrap companies also report using the first-aid techniques learned on the job to save the lives of people away from work. For instance, Rusty Griffin of D.H. Griffin Wrecking Co. Inc. (Greensboro, N.C.) once saved the life of a man he knew professionally when he recognized the man’s truck stopped on the road. Turns out the man had suffered a heart attack, explains Ray Coleman, Griffin’s safety director. Likewise, in the ReMA safety video, Miller Compressing’s Bill Reik cites two occasions when he used the Heimlich maneuver—another feature of many first-aid programs—to rescue children who were choking.
What Would OSHA Want?
Some scrap companies offer CPR/first-aid training to employees on a strictly volunteer basis. Others require the training for key staff, such as supervisors and lead personnel. D.H. Griffin started training its site supervisors and lead workers to be proactive about safety, but it has since discovered that more and more of its largest demolition jobs now require such training, notes Coleman.
Moreover, OSHA does require first-aid training—and recommends CPR training with annual recertification—in certain situations. OSHA Standard 1910.151(b) says employers shall have someone “adequately trained to render first aid” when there’s no “infirmary, clinic, or hospital in near proximity to the workplace.” The CPR training recommendation is then found in the agency’s first-aid training guidelines.
Unfortunately, OSHA has never defined what exactly “near proximity” means, says Mike Mattia. Is one mile close enough? What about five miles? And how might that differ between urban and rural worksites, or under various traffic conditions?
OSHA has discussed “near proximity” in terms of response time, however. The agency says employers shall train someone to render first aid in situations that involve suffocation, severe bleeding, or other life-threatening or permanently disabling injuries or illnesses when “outside professionals” such as paramedics can’t respond to the accident within three to four minutes. A 15-minute response time is acceptable for situations that aren’t life threatening or that don’t pose the likelihood of permanently disabling injuries, OSHA adds.
What to Cover
Remember, though: Even if your company does train people to administer CPR or first aid, those techniques are just meant to keep a person alive until the “outside professionals” arrive. So it’s vitally important to make sure that the paramedics or other responders know about your emergency and that they can find your facility, Mattia says. That’s why your employees also need to be trained and prepared to call the emergency phone number 911 in any life-threatening situation (for more information, see “Call First” on page 102).
But after calling 911, what then? What information or techniques should your training cover? What equipment do you need? Scrap processors who offer or require this training focus on several key areas.
At Annaco Inc. (Akron, Ohio), for instance, the basic CPR and first-aid training is mandatory and offered on company time to all supervisors, maintenance mechanics, and lead persons, explains Bob Toth, human resources manager, who also manages safety. Other employees can take the course on their own time at, say, a local Red Cross center, with Annaco paying the course fees, he adds.
Scrap companies find various ways to offer these courses, which tend to take four to eight hours, presented all at once or split into two sessions on separate days. Instructors can be experts brought in for the classes or even certified employees who can teach their colleagues. For instance, paper recycler E.L. Harvey & Sons Inc. (Westborough, Mass.) previously used a trainer from the local fire station until one of its own employees became a certified instructor, notes Gerry Sjogren, safety director.
In addition to CPR for adults—which includes mouth-to-mouth resuscitation—some processors offer training in the different techniques for administering CPR to children as well as the Heimlich maneuver, how to deal with severe bleeding from traumatic injuries, caring for broken bones, and other injuries.
Several scrap firms are even interested in training their employees in how to use an automatic external defibrillator (AED), the so-called “heart shocker” machines that airports and airplanes have been installing to restart the heart of someone suffering cardiac arrest. But there is a caveat: Though a recent American Heart Association study did show increased survival rates for emergency plans that combined traditional CPR with AEDs, the AED should never be treated as a substitute for performing CPR. It’s the CPR that keeps the blood oxygenated and flowing so the person does not suffer preventable brain damage, explains Mike Mattia. In other words, he says, “Don’t stop CPR until the guy with the AED is right there, and he’s got the paddles charged and ready to go.”
Moreover, like CPR itself, there’s only a short period of time during which defibrillation will do any good, Mattia notes. Others stress the importance of keeping the AED’s batteries charged and making sure that the paddles—which are replaced from time to time—are compatible with the machine being used.
Other useful equipment includes flexible shields or barriers for employees with concerns about mouth-to-mouth resuscitation. Assad Iron & Metals took that concept one step further, recently purchasing hand-squeeze two-way breathing bags that enable a responding employee to keep someone resuscitated while avoiding actual mouth-to-mouth contact. “People are a lot more comfortable doing it that way,” notes Vic Alfieri.
It also helps to know which employees have special medical needs or conditions—such as diabetes or epilepsy—and to have them wear medical ID bracelets or tags, Mattia says. That way, first-aid responders will know what to do and what not to do if, say, Joe in maintenance has an epileptic seizure (for example, trying too hard to restrain Joe could make him break an arm or leg, Mattia notes). And it’s good for the employer to know about temporary medical conditions—such as when an employee is taking powerful prescription painkillers. It’s a tricky area, of course, due to privacy concerns, but so long as employees know they won’t be fired or otherwise penalized because of their medical status, the information is useful to have, says Mattia.
Do No Harm
Doctors are admonished by the Hippocratic Oath to “first, do no harm.” That’s good advice for first-aid responders as well. Learning what not to do in an emergency medical situation can be just as important as learning CPR or other techniques, Mattia notes. For instance, almost everyone has heard about using a tourniquet to stop bleeding, but people need to know that tourniquets should only be applied as a last resort. The tourniquet cuts off the flow of blood to everything beyond it and begins to kill the tissue after that constricted point in a matter of minutes, Mattia says. So only use a tourniquet “when you’ve decided it’s worth the risk of having the rest of the arm or leg amputated,” he warns.
At D.H. Griffin, for instance, Ray Coleman once had to use his own belt as a tourniquet to save the life of an employee whose leg was sheared off in a skid-steer accident. The leg was already lost, he explains, but the employee survived.
So be sure responders know that alternatives to tourniquets include applying direct pressure to stop the bleeding, elevating the limb, or even using a tourniquet that can be alternately tightened and loosened. “The wound will still be bleeding,” Mattia notes, “but the rest of the arm or leg will get some blood flow.”
Mattia also advises first-aid responders to heed the well-known admonition against moving an accident victim with a potential spinal injury. If it’s raining or cold, put up some kind of tent or find another way to shield the person from the elements, he says, but don’t move him or her, or you risk making the injury worse.
In addition, responders should never try to remove an impaled object—no matter where it is. “The worst thing in the world is to see someone with something sticking in his eye,” Mattia concedes, “but what they teach medics to do is stabilize the object and get the person to where he can be helped.”
A particularly tough call involves a person pinned under a heavy object, such as a bale or pallet. At E.L. Harvey & Sons, an employee was once trapped under a heavy paper bale that broke his pelvis. The bale had to be lifted off before the man could be airlifted to a hospital. Mattia also knows of cases where the internal damage is so extensive, the pressure from the heavy object is the only thing preventing the person from bleeding to death. In those cases, special techniques—including a type of inflatable suit to maintain pressure even after the object is lifted off—can save the person’s life, but only if the weight is left in place until everything is ready, Mattia explains.
Gray Hats and Gray Areas
Making sure your trained responders are available and willing to help when needed is another key point. For instance, Grossman Iron & Steel Co. (St. Louis) trains all supervisors in CPR/first aid and then designates first responders based on their geographic location around the plant, with the person’s own interest level being one of the factors in their selection, explains Cap Grossman, president and CEO. Annaco requires similar training for all of its supervisors, lead personnel, and maintenance mechanics, and then provides them with blue or gray hardhats—which helps employees know to look for those color hardhats if there’s an emergency, says Bob Toth.
While Annaco’s training program is mandatory for certain jobs, no one is forced into a situation he or she can’t handle. “We’re saying you have to receive the training, but we’re not saying that you personally must respond and take care of an injured employee,” Toth says. He’s certain, though, that “somebody will instinctively want to help.”
Workers’ compensation rules generally protect employers from being sued in cases of employee accidents, and many states have so-called “good Samaritan” laws that likewise protect people who respond to emergencies. There are gray areas of liability regarding first aid, however, Mattia says. For instance, an improperly trained responder might cause further injuries that represent the sort of “egregious” action that negates workers’ comp protections or that prompt a customer or visitor who received inadequate treatment to sue.
One way to lessen such liability is to avoid actually designating anyone as a first responder, Mattia says. Instead, offer CPR/first-aid training as part of an overall health and wellness effort that includes other courses such as smoking cessation or improving nutrition. That way, the employer is simply being a good corporate citizen. Otherwise, the company exposes itself to tricky issues such as whether it needs to monitor the retraining and recertification of its responders, says Mattia.
Plus, OSHA has ruled that designated first responders must receive special training in dealing with bloodborne pathogens and have specific safety gear available, while the company must comply with certain recordkeeping rules. These extra measures aren’t required, though, if responders are simply employees who volunteered to take some first-aid courses and then decided to help out in an emergency, Mattia says.
For Cap Grossman, who made safety a focus of his tenure as ReMA president from 1994-1996, liability concerns are just part of doing business in the modern world. So he’s willing to accept whatever legal risks are involved in trying to help a sick or injured person. “I’d rather go to court and hash it out as opposed to going to a funeral home,” he says.
Support and Reality
Safety directors at scrap processing operations cite top-management support as a crucial factor for success of CPR/first-aid training. For instance, Gerry Sjogren of E.L. Harvey & Sons says the active involvement of Harvey family members—many of whom are CPR-trained themselves—is “just incredible.” Likewise, Vic Alfieri praises the Snyder family, which owns Assad Iron & Metals, for their “150-percent support” of this training.
Even when employees learn all these techniques, they need to realize that they’re not miracle workers. Cap Grossman’s determination to respond even at the risk of being sued stems, in part, from the time one of his employees died before CPR or first aid could be administered. Other processors report similar experiences, sometimes helping to stabilize a person who later died at the hospital.
That’s what happened at Assad in an earlier incident when another customer collapsed with a heart attack. “It was tough—the first time you had to do it, the guy didn’t make it,” Alfieri says. This incident, however, makes last year’s lifesaving incident so much more rewarding—especially when the man’s family sent a holiday card saying they were having a Merry Christmas because their husband and father was still around.
“It doesn’t get any better than bringing back somebody who was actually dead,” Alfieri says.
Call First
Calling 911 is often the most important act anyone can do in a medical emergency. Simple as that sounds, there are key points to remember, says ISRI’s Mike Mattia.
For starters, employees need to know that if they’re told to call 911, they should do it immediately. “It’s human nature to hesitate, to ask ‘Why?’ or ‘What happened?’” Mattia says. So make sure everyone knows to call first, ask questions later.
Given the size of many scrap plants, it’s also critical that employees have access to a phone or some means of contacting the main office. Grossman Iron & Steel and D.H. Griffin, for instance, supply key personnel with Nextel cell phones that serve as a walkie-talkie for communicating around the worksite and allow the user to directly contact 911 in case of an emergency. E.L. Harvey & Sons has a series of emergency phones around the plant that activate the public address system and contact the company dispatcher.
Once you reach the 911 operator, be ready to answer some key questions, including the nature of the emergency. That’s important because a different team with different equipment might be sent if a person has stopped breathing as opposed to someone who has broken a leg, Mattia explains. Also, make sure everyone knows how to direct the ambulance to the exact location of the incident. For instance, can your employees give the correct address for the nearest gate or street to where the incident occurred rather than simply the company’s head office?
At E.L. Harvey, an emergency-response plan focuses on that issue. “We have somebody immediately dispatched to the gate to wave the ambulance into the right entrance,” explains Gerry Sjogren. “Then we have an intermediate person pointing, showing them which road to take, and we have people waiting outside the building or the particular area, waving to them and showing them where they need to be.”
Likewise, Grossman Iron & Steel has a procedure to keep a train from suddenly appearing on the many tracks located around the yard and blocking the ambulance, explains Cap Grossman.
Too Much of a Test?
Even the best training needs to be tested, of course. That’s why scrap processors hold safety demonstrations or stage emergency-response drills, sometimes in cooperation with their local fire department. But don’t make the drill too realistic, warns Cap Grossman of Grossman Iron & Steel.
His company staged a mock medical emergency about 10 years ago in which an employee in an elevated crane appeared to have a heart attack. Only a handful of executives, the employee in the crane, and the fire department response team knew that the heart attack was being staged, explains Grossman, “so the entire plant had to react to what they thought was an actual crisis.”
The drill focused on bringing the employee down safely and stopped short of actually administering CPR or other first aid, Grossman says. Fortunately, this mock incident did demonstrate that the firm’s employees were properly trained to respond.
There was a problem, however: “We didn’t take into account how everybody was going to react emotionally when a bunch of the guys thought a friend of theirs was having a heart attack,” notes Grossman. As a result, the company still holds emergency-response drills, “but now everybody’s pretty much in the know,” he says. •
Robert L. Reid is managing editor of Scrap.
From teaching CPR to making sure employees know the proper way to call 911, safety-focused scrap processors know that good training can make the difference between life and death.