So, you’ve got your rescue team up to date on all the nifty tricks in confined space rescue. Litters, knots, anchoring, mechanical advantage systems, the whole kit, and kaboodle. Now, you’ll need some first aid and CPR training to meet OSHA’s standards. Some folks say a simple layperson first aid course will do it. Others argue that teams need a week-long EMS professional course to prepare. Going further, some folks say that investing in drills and skills retention is the most critical issue. To cut through some confusion, let’s look at some of the things employers might factor in when choosing medical training for Emergency Response and Rescue Teams.

What’s the Standard?

OSHA 1910.146(k) requires that employers “Train affected employees in basic first-aid and cardiopulmonary resuscitation (CPR),” and “ensure that at least one member of the rescue team or service holding a current certification in first aid and CPR is available.” That’s a lot, so let’s take a second to dissect this by defining some terms. According to OSHA, “First aid refers to medical attention that is usually administered immediately after the injury occurs and at the location where it occurred. It often consists of a one-time, short-term treatment and requires little technology or training to administer.” Alright, that’s pretty straightforward.

Now, let’s take a look at CPR or Cardiopulmonary Resuscitation. Simply put, rescuers will perform chest compressions to pump blood around the body and typically breathe for the patient. But wait, don’t I need to shock the patient? What about the AED (Automated External Defibrillator)? Am I required to have an AED in my first aid supplies? A 2004 letter of interpretation says no, AEDs are not specifically required in the rescue team first aid kit. However, AED’s are much easier to use today and an abundance of research says you probably should include one in your kit.

Here's why you may want to consider an AED. According to the American Heart Association, every minute after cardiac arrest without defibrillation, the patient’s chances of survival decrease by 7%-10%, and after 12 minutes, survival rates are as low as 2%-5%. In their 2020 guidelines, the AHA adds, “Defibrillation is most successful when administered as soon as possible after onset of VF/VT (lethal cardiac arrhythmias) and a reasonable immediate treatment when the interval from onset to shock is very brief. Conversely, when VF/VT is more protracted, depletion of the heart’s energy reserves can compromise the efficacy of defibrillation unless replenished by a prescribed period of CPR before the rhythm analysis.” If you have an AED handy, the rescue team is more likely to successfully resuscitate the patient rather than waiting for EMS or for someone to retrieve it from across the site.

Now that we’ve translated the standard let’s differentiate two of the most common training course types for rescue teams: Layperson First Aid and EMS/EMR Professional.

Professional Courses vs Layperson Courses

Although the topics and skills taught in basic first aid courses and EMS professional courses are similar, each route has unique advantages and disadvantages. For instance, and obvious to most folks doing the shopping, the price and time commitments vary. Typically, a simple layperson first aid course takes one day with around 4 to 10 hours of total time with the instructor. The American Heart Association, National Safety Council, American Red Cross, and other nationally recognized organizations offer First Aid CPR and AED credentials. So, although you’re only committing a single day you can trust, in most cases, that the information is solid to give your personnel a knowledge of the basics.

However, if you want your emergency response personnel to be able to take greater lifesaving measures, we highly recommend an Emergency Medical Responder (EMR) course. This is especially true if you are located in an industrial site with numerous hazards and possibly isolated from immediate medical care.

In an EMR course students will get around 50 hours of instruction, practice, and evaluation. According to the National Registry, “EMRs have the knowledge and skills necessary to provide immediate lifesaving interventions while awaiting additional EMS resources to arrive. EMRs also provide assistance to higher-level personnel at the scene of emergencies,” EMR is one of the most common medical certifications amongst both volunteer and professional responders. They are typically regulated by a state EMS education agency and taught by private businesses with licensed instructors.

From my personal experience as a Paramedic, I can say that receiving a patient from a layperson with first aid and a trained EMR can make a big difference. Oftentimes, this increases the viability of the patient – especially when access to professional medical care is not immediately available. The assessment taught to Emergency Medical Responders is almost identical to the scene assessment and patient surveys an EMT or Paramedic performs when responding to an emergency. As a component of your emergency response, medical care for the patient must be assessed and considered a vital part of any successful rescue operation.

Drills and Skills Retention

If you don’t use it, you lose it. Regardless of the course, the most critical component of any program is drilling and skills retention. In a 2020 study, a group of medical students went through a 40-hour BLS course. Immediately after training, 78% of the students were evaluated and categorized as “excellent.” However, 6 short months after the training, that number dropped to 40%.

What does this mean for your team? Should they retrain every 6 months? Maybe we could simplify their training to aid in retention.  Research conducted by the European Resuscitation Council (ERC) in 2019 showed an increase in 3-month skill retention after simplifying their guidelines. The simplest answer I can provide is to do what’s best for your unique situation.

Take a look at the hazards on your site, take note of the possible conditions and injuries, and perform a full-speed drill as often as you feel your team needs to stay proficient. If the one-year minimum for your confined space program shows a severe lack in team performance, try 6 months. If twice a year still reveals major gaps, move to 3 or even 4 exercises a year. The fact is, if you find the issues after someone is hurt or killed, the money, time, and resources you save will be nothing compared to the lives that are changed by the tragedy.

The best day to perform a rescue is the day after class. The rust builds up a bit every day that goes by. So, be proactive, aggressively shop the right course for you, and plan on investing heavily in site hazard-specific drills and rescue exercises that involve first aid and CPR. The families that work for you are betting their lives on it.

Conclusion

There are a lot of medical courses out there to choose from. What level of medical care do you want your team to have? One of a layperson to cover the basics or an EMS professional that sees the bigger picture of patient outcome and the continuum of care. Either way, if you don’t take your training seriously and prepare drills for your specific needs, the chances of catastrophe increase by the day. So, invest in your workforce's safety and peace of mind, give them the tools and perspective they need to be successful, and train hard.

References

1.https://www.osha.gov/laws-regs/standardinterpretations/2004-06-17-0

2.https://www.osha.gov/sites/default/files/publications/OSHA3317first-aid.pdf

3.https://www.osha.gov/medical-first-aid/standards

4.https://www.osha.gov/medical-first-aid/recognition

5.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600120/#ref19

6.https://www.ahajournals.org/doi/full/10.1161/circ.102.suppl_1.I-22

7.https://www.ahajournals.org/doi/10.1161/circ.140.suppl_2.139

Additional Resources

• Emergency Medical Responder Course
• First Aid CPR and AED Training Course

Safety professionals want to make sure all workers get home safely, but what are the best ways to do that?

Ask any safety professional what drives or motivates them to get out of bed in the morning and you’ll probably get 1,000 different answers. Some people may be motivated by their experience working in the industry, some may be motivated by combat experience, some may be motivated by their desire to help people and some may be motivated by money; the point is, we’re all motivated by something. While it’s great to know what motivates you, it’s even more important to ask yourself, “what impact do I want to make today?” 

Click here to read the full article by our own Chris McGlynn that was originally posted on OH&S’s website recently: https://ohsonline.com/articles/2022/12/05/how-to-make-an-impact.aspx?admgarea=news

Chris McGlynn is the Director of Safety/VPP Coordinator for Roco Rescue. He is a Certified Safety Professional (CSP) through the Board of Certified Safety Professionals as well as a Certified Confined Space and Rope Rescue Technician, and a Nationally Registered Paramedic. As Director of Safety, Chris oversees all corporate safety initiatives, ensuring that employees at Roco have the tools and training that they need to do their work safely and effectively. He is also responsible for managing Roco's Safety Services Division, which provides trained safety professionals for turnarounds and other special projects. Finally, Chris serves as the VPP Coordinator for Roco, continuing Roco’s long-standing commitment to excellence in safety and health. Roco has been an OSHA VPP Star Worksite since 2013.

Follow Chris 

Additional Resources

• Roco’s Professional Safety Services
• Want a Safer Workplace? Get Employees Involved!
  
  
  

There are so many angles to talk about in rope rescue but for now, let’s focus on Low Angle vs. Steep Angle vs. High Angle rescue.

We hear these terms utilized often in the rescue community, but it is not always clear what each term defines. Each one comes with a degree of slope range, something like;

• 0-15 degree slope is flat terrain
• 15-29 degrees is considered low angle
• 30-50 degrees is steep angle
• anything above 50 degrees is high angle

You may have heard some different numbers associated with each and that’s ok because, in reality, they are just guidelines to help us make informed decisions about what kind of systems to use in a given scenario. If I’m being honest, I don’t really care what the angle is because I still haven’t carried around a protractor in my rescue kit to tell me what degree slope I am working on. I have my own internal protractor, my eyes, my experience, and my level of training. All I am really concerned about is the steeper the ground, the more difficult and the more technical the rescue becomes.

It is not just the degree of slope that tells me what I need to do, it is also the terrain and the condition of the terrain that makes a BIG difference. The terrain AND the slope are going to be major factors in deciding what rope systems to use as well as how many personnel are involved in the rescue. Some examples of terrain that may push you to utilize ropes in a rescue situation would include loose rock/scree, mud, snow, or any other debris that could cause bad footing and an unstable rescue for the patient. Ropes may have to be used to gain access to the victim, to support the team members and the patients during the rescue and remove them from the rescue site.

It is not just the degree of slope that tells me what I need to do,
it is also the terrain and the condition of the terrain that makes
a BIG difference.

So, our size-up goes something like this.

• Can rescuers move freely across the terrain without assistance and manage patient movement effectively and safely? Yes = no ropes
• Do rescuers need assistance to safely and/or more efficiently move themselves or the patient, but the ground is predominately supporting the load? Yes = 1 rope system
• Are rescuers and the patient fully supported by the system or a single rope failure would cause catastrophic results? Yes = 2 ropes.

Each one of these scenarios presents its own set of challenges and the systems used can vary greatly. The goal for all of us is to provide for the safety of our teams and the people we are there to help.

Additional Resources

• 11mm Rope and NFPA Requirements
• Rescue Compliance...Is Your Team Ready?
  
  
  

It’s December 21^st on a Saturday night, and the plant is running on a skeleton crew. Operations wants to get a head start on annual preventive maintenance and decides to knock out several permit required confined space entries before the majority of the work is to be done after the New Year.

Randy has just finished the third of five vessels that are identical in configuration. He and his authorized attendant and good friend, Hector, have been working together for over 15 years and they both know the drill. They have changed out the stainless-steel bolt sets on the agitator blades of these vessels every year at about this same time. The entry supervisor has just closed out the permit for the third vessel. After reviewing the permit for the fourth vessel and helping with the pre-entry atmospheric monitoring, he signs the permit authorizing entry.

Hector checks Randy’s harness and the attachment of the non-entry rescue retrieval cable to his dorsal D-ring, and double checks the davit arm and the mounting point of the self-retracting lifeline with the built-in retrieval winch. As Randy climbs 25 feet down the rope ladder to access the bottom of the vessel, all is going according to plan. As he steps off the ladder and begins to loosen the first bolt set, he slips on the concave floor of the stainless-steel vessel. Before he can react, he strikes his head on the agitator blade which causes a 5-inch gash to his left temple and knocks him unconscious. He falls between two of the agitator blades and then slides to the bottom of the vessel with his retrieval line wrapped over one of the blades and under another. Hector tries to winch his friend out of the space only to find that Randy’s limp body gets wedged under the agitator blade. You can probably guess what happened next.

Keep additional personnel (even rescuers) out of the space
unless absolutely necessary.

Realizing there is no entry rescue capability on this shift, Hector’s gut reaction is to enter the space to help his friend. In his rush, he slips from the rope ladder and falls 20 feet to his death. When the entry supervisor arrives 30 minutes later to close the permit and initiate the last entry, he sees two bodies at the bottom of the space.

Understand OSHA Rescue Requirements  

Are there permit required confined spaces at your worksite? Are employees allowed to enter these spaces? If you answered yes to these two questions, it is critically important to understand the OSHA requirements for rescue. As part of a written permit space program, the employer must “Develop and implement procedures for summoning rescue and emergency services, for rescuing entrants from permit spaces, for providing necessary emergency services to rescued employees, and for preventing unauthorized personnel from attempting a rescue.”

When considering what methods should be used for rescuing authorized entrants, the safety of the rescuer(s) should be considered as important as the effectiveness of the rescue technique. If it is possible to perform non-entry rescue of the entrant(s), that should always be the first choice. It’s always a given – keep additional personnel (even rescuers) out of the space unless absolutely necessary. It is important to consider potential scenarios that could arise when determining if non-entry (or retrieval) rescue is sufficient.

Non-Entry Rescue

What are the requirements for non-entry rescue? OSHA states, “To facilitate non-entry rescue, retrieval systems or methods shall be used whenever an authorized entrant enters a permit space, unless the retrieval equipment would increase the overall risk of entry or would not contribute to the rescue of the entrant.”

An assessment should carefully consider both capabilities and limitations of the retrieval system for any planned or unplanned condition that may arise during entry.

Let’s examine this further. What conditions would preclude the use of non-entry retrieval systems? Here are some guidelines that OSHA will use to make this determination:

• A permit space with obstructions or turns that prevent pull on the retrieval line from being transmitted to the entrant does not require the use of a retrieval system.
• A permit space from which an employee being rescued with the retrieval system would be injured because of forceful contact with projections in the space does not require the use of a retrieval system.
• A permit space that was entered by an entrant using an air supplied respirator does not require the use of a retrieval system if the retrieval line could not be controlled so as to prevent entanglement hazards with the air line.

Assess The Space

The ONLY way to determine if a non-entry retrieval system will provide adequate safety for entrants and satisfy OSHA’s requirement is to perform an honest and thorough assessment. This assessment should provide careful consideration for the capabilities and limitations of the retrieval system for any planned or unplanned condition that may arise during entry. We have all heard of “Murphy’s Law” and most of us have experienced the effects of that particular law. I encourage you to remember that Murphy is always lurking close by.

So, when evaluating these spaces to determine if non-entry or entry rescue is the appropriate choice, always ask yourself “what if?” For the fictitious accident that opened this article, the plan was to do all the work on the near side of the agitator blade directly below the top portal. In that case, it would have been safe to assume non-entry retrieval was the only plan needed for rescue. Enter Murphy… Was the rescue plan developed with the assumption that the planned work activities would always ensure the successful use of the retrieval system, but failed to consider the “what ifs”? Some might say that we can “what if” things to death. Let’s turn that around; we SHOULD “what if” these questions in an effort to PREVENT death.

If there is any reasonable potential for an unplanned change
in the conditions, then an entry rescue capability
must be in place as a backup.

When evaluating permit spaces to determine the appropriate rescue capability, please explore those “what ifs.” This is not to say that in the case cited above that the only option would have been entry rescue. That may not be necessary and if the non-entry retrieval system would have worked, then there is no need to expose rescuers to the hazards of entering the permit space. But there was a potential for the condition to change, and it sure did. So, recognizing that potential, an entry rescue capability should have been planned in the event that the change in conditions rendered the non-entry rescue system ineffective.

Backup Plan

The point of this article is to consider non-entry rescue as the default for assisted permit space rescue unless the conditions cited by OSHA are present. At that point, entry rescue must be planned. But this isn’t necessarily a one or the other choice. As we can see from this story, it is sometimes best to plan for non-entry rescue as the primary technique, but if there is any reasonable potential for an unplanned change in conditions, then an entry rescue capability must be in place as a backup.

This article was originally featured on the cover of the March 2014 issue of ISHN, and authored by retired Roco Chief Instructor Pat Furr.

Additional Resources

• Non-Entry Confined Space Rescue…Are You Sure?
• Confined Space Types - Are All Your Bases Covered?
• Confined Space Rescue Types Chart & Compliance Guide (pictured here)
  
  

Companies with active safety and health programs that train workers to identify hazardous conditions and use required protective measures can prevent serious and fatal injuries.

In Centre County, PA, three family members died in a grain silo incident. A father, age 47, and his sons ages 14 and 19 all died after becoming trapped inside a silo. The family members reportedly died from asphyxiation due to gasses in the silo. Neighbors said it was a ripple effect with one going in to help the next when they all eventually succumbed to the hazardous atmosphere inside the space.

Tankers Can Be Death Traps

A 48-year-old worker entered a tanker-tailer in Lemont, IL, to inspect it as part of an annual U.S. Department of Transportation requirement and was overcome by exposure to bleach and chlorine gas. The worker was found unconscious in the tanker-trailer; however, he later died of his injuries.

An OSHA investigation determined that the worker’s employer had failed to:

1. identify and evaluate atmospheric hazards in the confined space,
2. train workers on the confined space program, and
3. ensure employees filled out a confined space permit before entry into a confined space.

OSHA also found that the employer failed to equip the worker rescuing the unconscious employee with a retrieval system, implement its own procedures for summoning rescue and emergency services and numerous other violations of its permit-required confined space regulations.

The company was also cited for failing to provide fall protection to an employee working on top of tanker trailers and providing training on fall hazards, respirators, and hazard communication.

The Chicago regional office established a Regional Emphasis Program in 2021 due to the dangers involved in inspecting tanker-trailers. The program is designed to reduce the risks tank cleaning workers face.

“In recent years, OSHA has investigated instances in which workers suffered tragic injuries because employers failed to follow appropriate procedures for ensuring healthy atmospheric conditions inside a confined space and use of adequate respiratory protection before allowing workers to enter tanks,” explained the OSHA Area Director.

Additional Resources

• Attendant Safety Requirements Poster (pictured here)
• Confined Space Entry Checklist
• Common Causes of Confined Space Fatalities