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The first and possibly most important rule to first aid is if the employee has not been trained to give first aid. DON'T try it. More harm than good may be done from improper actions. It is not only important to know what to do, but also what not to do concerning first aid.
Situations that are life-threatening require immediate action CALL 911 or ask someone nearby to CALL 911 and then try to talk to the person and offer to provide care for health issues such as: heart attack, stroke, stopped breathing, heavy bleeding, poisoning, accidental electrical contact and shock. At the onset of sudden illness or injury summon help and give immediate attention to first aid priorities.
  • Stay calm.
  • Effect a quick rescue while keeping in mind your own safely as well as the victims.
  • Do not move victim unless he or she is in danger of further injury.
  • Keep victim in same position as found until aid arrives.
  • Check for life threatening conditions.
  • Assess/Control/Monitor 1) Airway 2) Breathing 3) Circulation (ABC's)
  • Control bleeding
  • Treat for shock
  • Keep onlookers away

Controlled Exposure

  • Any procedures involving unknown body fluids or blood require additional care to limit splashing, spraying, or splattering of fluids.

  • You must be trained in Blood Borne Pathogens (BBP) and must use the protective gear provided in a BBP kit before administering aid to a person who may expose you to blood, saliva or bodily fluids.

  • Do not eat, smoke, drink, apply cosmetics, lip balm or handle contact lenses when unknown body fluids or blood are present.

Personal Protection Equipment and Hygiene
  • When there is a potential for exposure personal protection equipment SHALL be used.
  • Latex gloves, face masks, and antiseptic towelettes provided in all Blood Borne Pathogen (BBP) kits SHALL be worn and used when exposure to blood or saliva is possible.
  • While performing mouth-to-mouth resuscitation a CPR shield and latex gloves SHALL be worn and used.
  • First aid kits SHALL be inspected weekly and used items replaced.
  • All personal protection equipment SHALL be replaced immediately after use if it cannot be cleaned or decontaminated.
  • Washing of hands and any exposed areas with soap and water SHALL be done as soon as possible after first aid treatment is completed and protective equipment removed.
  • If facilities are not available for washing up after treatment the use of antiseptic towelettes SHALL be used.
  • During any cleanup involving blood or body fluids BBP personal protective equipment SHALL be worn as needed.
  • After contact with blood and body fluids employees who administered aid SHALL dispose of BBP used items carefully to avoid brushing the contaminated items against clothing, carpet or work surfaces by disposing of the contaminated items in the provided hazardous waste bag, dispose of the bag in a certified hazardous waste dump site and then make sure to thoroughly clean all of the areas of your skin that may have come into contact with blood or bodily fluids.
  • All first aid equipment, clothing, etc. that is not contaminated with blood or any body fluids can be washed or disposed of as regular waste.
  • All first aid equipment, clothing, etc., that is contaminated with blood or any body fluids SHALL be disposed of as hazardous waste in a Hazardous Waste Bag.
Serious Wounds and Bleeding, Proper Use of Blood Born Pathogen Kits
  • The major objectives for first aid of serious wounds are to: control bleeding, prevent contamination and infection, care for shock, and call for medical help.
  • Before attending to the injured person, make sure that you are trained in proper use and recognize that you must use the Blood Borne Pathogen (BBP) kit provided on every truck.
  • Apply direct pressure on the wound with a pad or cloth, but if none are available use your hand until one can be obtained. Once a pad has been applied to stop the flow of blood do not remove it. If the pad becomes saturated add additional pads over the first one applied, the less a bleeding wound is disturbed, the better the chance of stopping the bleeding.
  • If bleeding continues and no fractures are suspected, or serious pain is present, elevate the wound above the heart and continue applying direct pressure. If bleeding does not stop, the next step is to apply pressure at pressure points while continuing to use direct pressure on the wound. After the flow of blood stops, maintain direct pressure and slowly release pressure on the pressure point.
  • Remember pressure points are only to be used if direct pressure fails to reduce or stop the flow of blood.
  • As a final procedure to stop and control bleeding use of a pressure bandage may be necessary. A tight bandage is used to hold the pad or dressing in place while maintaining direct pressure on the wound. Frequently check the fingertips or toes of extremities along with pulse while the pressure bandage is applied. If the bandage is too tight, the pulse rate may be slowed or absent.
  • A tourniquet should only be used for severe, life-threatening hemorrhage that cannot be controlled by other means. Direct pressure, elevation and pressure points shall be tried first. If a tourniquet is used apply it above the wound and a note SHALL be placed on the victim listing the location of and time. The longer a tourniquet is in place the greater the chance of causing extended damage to the limb. Victim SHOULD be transported to a medical facility as soon as possible.
  • As soon as the victims bleeding is under control and help contacted, give care to prevent or treat for shock (see section on shock).

Internal Bleeding
Signs and symptoms of internal bleeding are:

  • Bruised, swollen, tender or rigid abdomen.

  • Bruises on chest or signs of fractured ribs.

  • Blood in vomit.

  • Wounds that have penetrated the chest or abdomen.

  • Bleeding from the rectum or vagina.

  • Fractures of the pelvis.

  • Abnormal pulse and difficult breathing.

  • Cool, moist skin.

If a person has any indication of internal bleeding, immediately call 911 and relay the symptom information to the ambulance dispatch person over the phone.
Guidelines for Administering First Aid
If the injury appears to be a simple bruise, apply cold packs (do not put ice directly on the skin) to the area to prevent tissues from swelling and to slow internal bleeding.
If it is suspected there's more severe internal injury, get medical help immediately. While waiting for help:

  • Monitor ABCs 1) Airway 2) Breathing 3) Circulation (ABC's)

  • Reassure the victim and keep him or her still.

  • Control ail external bleeding.

  • Care tor shock (see section on shock)

  • Loosen any tight-fitting clothing.

  • If the victim is vomiting, place victim lying down on his/her side so that fluids can drain from the mouth easily

Small Wounds and Nose Bleeds
  • Any wound even if it is small such as a common nose bleed the person providing assistance must be trained in BBP and use the appropriate items in the BBP kit before administering aid to anyone with a small wound or nose bleed.
  • If trained in BBP and after putting on the appropriate BBP protective gear, then administer assistance. Any break in the skin is a wound and may become infected. Treat all wounds, no matter how small, with first aid attention. Wash wound and surrounding area with soap and water, applying a mild antiseptic, allow drying, then cover with a sterile bandage.
  • Check wound often for any signs of inflammation or infection and redness, odor, pain, or drainage present. If found a Doctor SHOULD be consulted as soon as possible.
  • Puncture wounds are more likely to become infected than open wounds. Punctures do not often bleed freely, and thus clean themselves.
  • Puncture wounds being difficult to clean offer more chance for infection and must be watched closely for the same signs as an open wound. First aid for puncture wounds is much the same as for open wounds with the exception that o tetanus antitoxin SHOULD be given by a physician, if necessary.
  • Do not clean or disturb scabs or clots of more serious wounds. If disturbed the wound may start bleeding again. If a wound is large, deep, or has been bleeding heavily treat the wound in the same manner as described for serious wounds and bleeding. Consult a physician for cleaning and further treatment.

​For aid in stopping a nosebleed:
  • Sit down and lean forward.
  • Apply cold, wet compresses over the nose. Use of a cold pack or ice pack is recommended.
  • Apply direct pressure by pinching both nostrils shut until the bleeding stops.
  • If the bleeding does not stop pack the nostril lightly with gauze, leaving a small piece sticking out for removal later. Seek medical attention as soon as possible.
Assisting A Person in Shock
Shock can be life threatening if not treated. Shock can happen to anyone who is badly hurt or lost large amounts of bodily fluids. Shock depresses the body functions and may keep the lungs and heart from working property. Extreme pain or fright can make the effects of shock worsen. A victim suffering from shock can die, even if the injury sustained is not life threatening.
Shock has numerous signs and symptoms. Included are:
  1. Confused behavior
  2. Very fast or slow heart rate
  3. Trembling and weakness in arms and legs
  4. Cool and moist skin
  5. Pale or bluish skin, lips, and fingernails
  6. Enlarged pupils.
Call 911 immediately to request an ambulance. It is very important to get this person to the hospital as soon as possible
  • Have victim lay down, if possible, depending on injuries and elevate feet. If victim has a head or neck injury, keep him or her lying flat and wait for EMS.
  • Do not move victim unless he or she is in immediate danger from extreme hazards. If a victim must be moved, avoid bending or twisting the body.
  • Protect victim from extremes of heat or cold while trying to maintain body temperature. Keep victim warm enough to prevent chilling, but do not overheat them. Getting cold reduces the flow of blood, while overheating will draw blood away from the vital organs. Protect victim from the elements-if needed (rain, wind, snow. etc.).
Both injury and sudden emotional shock can cause fainting.  If victim recovers and still feels odd, have victim lower their head between knees or loosen tight clothing around neck. Have victim lie down until fully recovered.
If victim remains unconscious, monitor Airway-Breathing-Circulation, call 911.
The general signs and symptoms of stroke are weakness and numbness of the face, arm, or leg, often on one side only. Other possibilities are dizziness, confusion, headache, ringing in the ears, a change of mood, difficulty in speaking, unconsciousness, pupils of unequal size, difficulty in breathing and swallowing, and loss of bowel and bladder control.
Call 911 immediately to request an ambulance. It is very important to get this person to the hospital as soon as possible.
  • Reassure the victim and let him or her find the most comfortable position for breathing.
  • Do not give any thing by mouth.
  • If the victim vomits, place him/her on the affected side so that any fluids can drain from the mouth.
  • Monitor Airway - Breathing – Circulation
Some individuals have on aura (sensation) before the onset of a seizure. Auras can be sound and vision hallucinations, a strange taste in the mouth, abdominal pain, numbness, or a sense of urgency to move to safety. Seizures can range from mild to severe: brief blackouts, involuntary movements, sudden falls, periods of confused behavior, and convulsions (involuntary muscle contractions). Severe seizures may involve uncontrollable muscle movements (jerking or spasms) and rigidity, loss of consciousness, loss of bladder and bowel control, and, in some cases, breathing that stops temporarily.
If it is known the person has epilepsy, it is usually not necessary to call 911 unless:
  • The seizure lasts longer than a few minutes.
  • Another seizure begins soon after the first.
  • He or she does not regain consciousness after the jerking movements have stopped.

Call 911 when someone having a seizure is:
  • Pregnant
  • Carries identification as a diabetic
  • Appears to be injured
  • Is in the water and has swallowed large amounts of water

A person having a seizure cannot control it. Injuries to him or her can be prevented by removing anything nearby that might get in the way, such as: furniture, equipment, etc. Injuries can also be prevented by not interfering. Do not put anything between the teeth. Also, do not hold or restrain the person. Loosen clothing and roll him or her on side should they vomit.
Diabetic Emergency
In a diabetic emergency, it is possible to confuse the signs and symptoms of insulin reaction and diabetic coma. Since insulin reaction is a true emergency that needs quick response, and the person is conscious, give them sugar. If instead of having an insulin reaction, he/she is in a diabetic coma, the sugar will not cause further harm.
If the person is unconscious, monitor Airway - Breathing – Circulation and call 911 immediately.
Heat Stress Related Conditions
All Energy Group, Inc Managers, Supervisors, General Foremen, and employees shall receive CPR, AED, and First Aid Training upon hire, and bi-annually. This training shall include Heat Related Illness and Emergency Response (Appendix 1.)
Working in warm temperatures during the summer months may increase your body temperature. An increase in body temperature can affect mental alertness and physical performance. Heat tends to increase the potential for experiencing an accident due to such factors as sweaty palms, dizziness, and fogged glasses.
As our industry requires employees to work outdoors in the summer months, extra precautions should be taken when the outdoor temperature is excessively high. Climbing, operating power tools and equipment, and dragging brush can contribute to the possibility of, getting overheated, heat exhaustion or even heat stroke. General Foremen need to evaluate environmental and personal factors before assigning work in excessive temperatures - This shall include evaluating the employee’s physical condition, level of fatigue, hydration, etc., and enforcing the following:
  • Do not climb ladders, poles, or trees if you are feeling fatigued, or overheated.
  • Do not use chainsaws or power tools if you are feeling fatigued or overheated.
  • Do not operate equipment such as chippers or grinders if you are feeling fatigued or overheated.
  • Do not drive company vehicles if you are feeling fatigued or overheated.
  • Do not drag brush if you are feeling fatigued or overheated.
Heat Stress disorders such as heat stroke and heat exhaustion are more likely to occur among workers who have not adjusted to the summer heat environment. Every employee should be aware of and observe each other for signs of heat stress during the year.
It is important to drink plenty of fluids like Gatorade and water (one cup every fifteen to twenty minutes). Gatorade and other "sport drinks" are a good source to replenish electrolytes in your body. Limit your intake of caffeine (coffee, soft drinks, etc.) as it tends to dehydrate your body.

Heat Stroke is a type of heat stress that occurs as the temperature of the body rapidly rises. This is very dangerous and should be dealt with immediately. Heat stroke can be fatal if the affected individual is not given the appropriate treatment.
Symptoms of heat stroke include confusion, convulsion, hot dry skin, high temperature (may feel chilled), incoherent speech, staggered gait, lack of sweating and unconsciousness.

When a person has heat stroke, the body's ability to sweat becomes impaired which in turn increases the body's core temperature. If the situation is not quickly reversed it can be fatal.
Treatment: Call for medical assistance immediately. Do not wait for medical help to arrive to begin treatment. Move the victim to a cool, shaded environment and allowed to rest by lying down. If available, submerse the victim in chilled water. If you are unable to submerse the victim, wrap the individual in a thin, wet sheet and fan continuously, adding water periodically to keep the sheet wet.
Heat Exhaustion is type of heat stress which occurs when lacking sufficient water and/or salt in the body. The body becomes dehydrated which decreases the blood circulation.
Symptoms of Heat Exhaustion include clammy skin, confusion, dizziness, lightheaded, fatigue, heat rash, fainting, nausea, profuse sweating, slurred speech, weak pulse.
Treatment: A victim of heat exhaustion should be moved to a cool, but not cold, and shaded environment and allowed to rest by lying down. Fluids should be taken slowly and steadily by mouth until the urine volume indicates that the body's fluid level is in balance.
Sunlight Exposure
During the summer months it is also important to remember that you are exposed to powerful rays of sunlight. Listed below are a few commonsense rules to follow to minimize sun exposure and the harmful effects it can have on your skin:
  • Wear a hat and sunglasses (tinted lens safety glasses are available).
  • If you can handle the discomfort, wear a long sleeve shirt (cotton).
  • Use a sun block, the higher the SPF rating the better.
  • When Necessary, seek shaded areas such as your Energy Group vehicle or portable shelter.
Water is available at all pullout locations, and coolers are provided to take the provided water to the jobsite.
Cold Related Illness Frostbite
Frostbite most often occurs during a high wind which takes body heat from the body. Considerable pain usually exists if the hands or feet are frostbitten. Cheeks, nose can often become frostbitten and are not painful. The victim may not be aware of their condition until someone tells them. Frostbitten areas become a dead grayish white because of ice-frozen tissue. Frostbite causes degrees of tissue damage.
Mild frostbite looks white or grayish, the skin feels hard, even though the underlying tissue feels soft. In moderate frostbite, large blisters form on the surface and in the tissues underneath. The frostbitten area is hard, cold, and insensitive. If freezing is deeper than the skin, tissue damage is severe. Gangrene may result from the loss of blood supply to the area.
Signs and Symptoms of Frostbite:
The first sign of frostbite may be that the skin is slightly flushed. The skin color of the frostbitten area then changes to white or grayish yellow and finally grayish blue, as the frostbite develops. Pain is sometimes felt early on but goes away. The frostbitten part feels very cold and numb. Often the victim is not aware of the injury.
Frost Bite First Aid:
Get the victim into a warm place. Place the frozen parts in warm not hot water. Handle parts gently, and do not rub or massage them. If the toes or fingers are affected put dry sterile gauze between them after warming them. Loosely bandage the injured parts. If a part has been thawed then refrozen, then you should re-warm frozen part at room temperature.
Hypothermia is cooling of the body due to extended exposure to low temperatures.
Signs and Symptoms of Hypothermia:
The signs and symptoms of hypothermia include shivering, dizziness, numbness, confusion, weakness, impaired judgement, impaired vision, and drowsiness. The stages are:
  • Shivering
  • Loss of consciousness
  • Decreasing pulse rate and breathing rate
  • Death
As hypothermia progresses, the victim may move clumsily and have trouble holding things. In the later stages, he or she may stop shivering.
First Aid for Hypothermia:
Call 911 Immediately. Get the victim of hypothermia out of the cold and into dry clothing. Protect the victim from the weather. Warm up his/her body slowly. Give nothing to eat or drink unless the victim is fully conscious. monitor Airway - Breathing – Circulation. Obtain medical assistance immediately.
First Aid for Bee Stings:
Bee, Wasp or Hornet:
  • Have someone stay with the worker to be sure that they do not have an allergic reaction.
  • Wash the site with soap and water.
  • Remove the stinger using gauze wiped over the area or by scraping a fingernail over the area. Never squeeze the stinger or use tweezers.
  • Apply ice to reduce swelling.
  • Do not scratch the sting, as this may increase swelling, itching and risk of infection.
First Aid for Fire Ant Stings and Bites:
Workers with a history of severe allergic reactions to insect bites or stings should consider carrying an epinephrine auto injector (EpiPen) and should wear a medical identification bracelet or necklace stating their allergy.
Workers should take the following steps, if they are stung or bitten by fire ants: Rub off ants briskly, as they will attach to the skin with their jaws.
Antihistamines may help. Follow directions on packaging. Drowsiness may occur.
Take the worker to an emergency medical facility immediately if a sting causes severe chest pain, nausea, severe sweating, loss of breath, serious swelling, or slurred speech.
First Aid for Spider Bites:
Workers should take the following steps if a spider bites them:
  • Stay calm.
  • If it is possible to do so safely, identify the type of spider. Identification will aid in medical treatment. Wash the bite area with soap and water.
  • Apply a cloth dampened with cold water or filled with ice to the bite area to reduce swelling.
  • Elevate bite area, if possible.
  • Do not attempt to remove venom.
  • Notify your supervisor.
Immediately seek professional medical attention.
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