Medical and other emergencies

Fire is the emergency most workplaces plan for first, but it is not the most common. Medical emergencies, such as cardiac arrest, serious injuries, allergic reactions, diabetic emergencies and overdoses, happen far more often. Workplaces also face hazardous material spills and releases, severe weather, power and utility failures, gas leaks, bomb threats and suspicious packages, violence and floods. This lesson gives an awareness-level overview of how to recognize and respond to these emergencies, how the emergency plan should handle them, and what first aid arrangements the law requires. It is not a first aid course: workers designated as first aiders need certified first aid and CPR training from a recognized provider.

The universal first steps

Whatever the emergency, the same first steps apply. First, check for danger to yourself and others: do not become a second casualty by rushing into a confined space, a chemical cloud or a live electrical hazard. Second, call for help: raise the alarm, call 911 and notify the site's first aiders and emergency coordinator. Third, care for the injured or affected as far as you are trained, and keep others away from the hazard. Fourth, meet and brief emergency responders. Many first aid programs teach a version of this sequence, such as check, call, care.

Medical emergencies

Sudden cardiac arrest is one of the leading causes of death, and many arrests happen at work. When the heart stops, survival falls by roughly 7 to 10 percent for every minute without CPR and defibrillation. Early recognition, an immediate 911 call, immediate CPR with hard and fast chest compressions in the center of the chest at 100 to 120 per minute, and use of an automated external defibrillator (AED) within the first few minutes can double or triple survival. AEDs are designed for untrained bystanders: they give spoken instructions and will shock only if a shockable rhythm is detected. Workplaces should place AEDs where they can be reached within about three minutes of any point, mark them clearly, check them regularly and train staff.

Other common medical emergencies at work include:

• Severe bleeding: apply firm direct pressure; use a tourniquet for life-threatening limb bleeding if trained and equipped.
• Choking: encourage coughing; if the person cannot breathe, speak or cough, give abdominal thrusts or back blows as trained.
• Stroke: recognize sudden face drooping, arm weakness, speech difficulty; call 911 immediately, noting the time symptoms started.
• Heart attack: chest pain or pressure, shortness of breath, pain in the arm, jaw or back, nausea; call 911, keep the person resting and follow dispatcher advice on aspirin.
• Anaphylaxis: rapid swelling, breathing difficulty, hives after exposure to a trigger; help the person use their epinephrine auto-injector and call 911.
• Diabetic emergencies: confusion, sweating, shakiness from low blood sugar; give sugar if the person can swallow.
• Seizures: protect from injury, do not restrain or put anything in the mouth; call 911 if the seizure lasts more than five minutes or the person is injured.
• Opioid overdose: unresponsiveness, slow or no breathing, pinpoint pupils; call 911, give naloxone if available and trained, and start rescue breathing or CPR.
• Heat stroke: confusion, hot skin, collapse in hot conditions; call 911 and cool the person rapidly, ideally by immersion in cold water.
• Burns: cool with cool running water for at least 10 to 20 minutes, remove jewelry, cover loosely; do not apply ice, butter or ointments.

First aid requirements in the United States

In the United States, OSHA 29 CFR 1910.151 requires that, in the absence of an infirmary, clinic or hospital in near proximity to the workplace, a person or persons be adequately trained to render first aid, and that adequate first aid supplies be readily available. OSHA has interpreted near proximity as a response time of 3 to 4 minutes for workplaces where serious accidents such as falls, suffocation, electrocution or amputation are possible, and up to 15 minutes elsewhere. Where eyes or body may be exposed to corrosive materials, suitable facilities for quick drenching or flushing must be provided; ANSI/ISEA Z358.1 sets performance requirements for eyewash stations and showers, including that they be reachable within about 10 seconds. ANSI/ISEA Z308.1 sets minimum contents for workplace first aid kits. Some industries have additional rules, such as construction (1926.50) and logging.

In both countries, the emergency plan should record who the first aiders are on each shift, where kits, AEDs, eyewash stations and emergency showers are located, how first aiders are summoned, and how injured workers will be transported to medical care. Workers who give first aid should be protected from bloodborne pathogens with gloves and CPR barriers.

Hazardous material spills and releases

Spills and releases range from a broken bottle of cleaner to a major chemical release. Small spills that workers have been trained and equipped to handle can be cleaned up using the spill kit and the safety data sheet, wearing the right PPE. Larger spills, unknown materials, releases of toxic gases, spills that reach drains, and any spill that causes symptoms require evacuation of the area, notification of the emergency coordinator and, as needed, 911 and the environmental regulator. Emergency response to hazardous material releases by trained teams is regulated: OSHA 1910.120 (HAZWOPER) in the United States, and provincial OHS and environmental rules in Canada. Workers at the awareness level should recognize the release, protect themselves, isolate the area, notify others and stay upwind and uphill.

Gas leaks and utility failures

Natural gas has an odorant added so that leaks can be detected by smell. If you smell gas, do not operate electrical switches, phones or anything that could produce a spark in the area; leave the area, warn others, and call the gas utility and 911 from a safe distance. Power failures can stop ventilation, lighting, alarms, pumps and process controls; plans should cover emergency lighting, safe shutdown of equipment, backup power and how to keep people safe in elevators. Water main breaks, flooding and loss of heating also need procedures, including protecting fire protection systems from freezing.

Severe weather and natural hazards

Depending on location, workplaces may face tornadoes, hurricanes, severe thunderstorms and lightning, blizzards and ice storms, extreme heat and cold, floods, wildfires, earthquakes and tsunamis. Plans should include how warnings are received (government alerting systems, weather services), triggers for actions such as stopping outdoor work, shelter locations and procedures, and how to account for people and communicate afterwards. Wildfire smoke and evacuation orders are an increasing concern for workplaces in both countries; plans should address air quality, protecting workers outdoors and evacuating vehicles and equipment.

Threats, suspicious packages and violence

Bomb threats are usually made by phone. The person who receives the call should stay calm, keep the caller talking, note exact words, background sounds and the caller's voice, using a bomb threat checklist, and report immediately to management and police. The decision to evacuate or search is made by management with police advice. Suspicious packages should not be touched, moved or opened; clear the area and call police. Workplace violence and active threats are covered in Lesson 9 (lockdown) and in workplace violence programs required by many OHS laws.

Confined space and rescue emergencies

Some of the deadliest workplace emergencies happen when untrained co-workers try to rescue a person who has collapsed in a confined space, such as a tank, vault, sewer or silo. Hazardous atmospheres that overcome one person will overcome the rescuer as well, and studies of confined space fatalities have found that a large share of the victims were would-be rescuers. Confined space work requires a rescue plan in advance, with trained and equipped rescuers available, non-entry rescue methods such as retrieval lines where possible, and atmospheric testing. The same lesson applies to other rescue situations: a worker in contact with an electrical source, a person trapped in machinery or a worker who has fallen into water or a trench. Call for trained help, control the hazard if you can do so safely, and do not enter.

Extreme heat and cold

Heat-related illness and cold stress are growing concerns as weather becomes more extreme. Heat stroke is a medical emergency: a worker who is confused, staggering or unconscious in hot conditions needs immediate cooling and a 911 call. Heat exhaustion, with heavy sweating, weakness, headache and nausea, requires rest in a cool place, water and monitoring. Prevention through water, rest, shade, acclimatization and work scheduling is covered in occupational health courses; for emergency planning, the key elements are recognizing the signs early, having a cooling method available (such as ice water immersion tubs or cooling towels) and having a clear trigger for calling emergency services. Cold emergencies include hypothermia and frostbite; move the person to a warm place, remove wet clothing, warm the body gradually and get medical help.

Mental health crises

Emergencies are not always physical. A co-worker may be in acute emotional distress, express thoughts of suicide or behave in a way that suggests a mental health crisis. Workers are not expected to act as a counselor, but they can stay with the person, listen without judgment, remove obvious means of harm if it is safe to do so, and get help: in immediate danger, call 911; otherwise, contact the employee assistance program or a crisis line. In Canada and the United States, the 988 number connects people to suicide and crisis support. Mental health first aid courses teach these skills in more depth. Including mental health crises in the emergency plan, with contact numbers and a designated person to call, makes a fast, caring response more likely.

Keeping emergency equipment ready

Emergency equipment only helps if it works. AEDs need monthly checks of the status indicator and replacement of pads and batteries before their expiry dates; first aid kits need restocking after each use and periodic checks; eyewash stations need weekly activation to flush the lines; and spill kits need replacing when used. Assign each item to a named person, use a simple checklist and record the checks.