Safety and Loss Prevention
Incident Response & Reporting
It’s impossible to foresee all injuries or incidents that may occur when working in uncontrolled environments, but first aid skills and having emergency plans in place will help manage situations effectively and potentially mitigate negative consequences. Once a situation is stable and urgent medical care needs are met, report incidents to campus to trigger University support and evaluation. Reporting procedures, as well as mechanisms to debrief and review lessons learned, are outlined below. As a University, we must also comply with a variety of reporting regulations, including but not limited to, reporting of injuries and fatalities to Cal/OSHA, Title IX reporting of sexual harassment and criminal behavior, environmental releases or spills, and loss/theft/misuse of research materials or funds. Related campus-specific policies and resources are listed in the appendix.
First Aid & Initial Response
This chapter outlines established protocols for first aid reference, but in no way is a replacement for maintaining current first aid certification. First aid training includes valuable hands-on practice that cannot be replicated in any other way. Keep your certs current! Refresher training and practice is vital to maintain competency in first aid. In California, it is the intent of the Good Samaritan Law to encourage individuals to volunteer to assist others in need during an emergency, but only provide treatment within the scope of your training level and never abandon a patient.
Life-Threatening Injuries or Illness
Call 911 or seek medical care immediately. Always know your physical location; everyone in your group should be able to provide Emergency Medical Services (EMS) accurate directions to the field site.
Basic First Aid
By administering immediate care during an emergency, you can help an ill or injured person before EMS arrive. A variety of useful references can also be downloaded to your smartphone (and are then accessible without cell or WiFi service) such as the Emergency Medical Response Guide or “EMR Guide” from the National Safety Council and “First Aid” from the American Red Cross. Both are available free from the App Store.
First Aid Steps (adapted from the American Red Cross1):
1. Scene Size Up
Before administering care to an ill or injured person, check the scene and the person. Size up the scene and
form an initial impression. Pause and look at the scene and the person before responding. Answer the following questions:
- Is the scene safe to enter?
- What happened?
- How many people are involved? - What is my initial impression about the nature of the person’s illness or injury?
- Does the person have any life-threatening conditions, such as severe, life-threatening bleeding?
- Is anyone else available to help?
2. Awake and Responsive
If the Person is Awake and Responsive and there is no severe life-threatening bleeding:
- Obtain consent: Tell the person your name, type and level of training, what you think is wrong and what you plan to do, and ask permission to provide care.
- Use appropriate PPE: Put on gloves.
- Interview the person: Use SAMPLE questions to gather more information about signs and symptoms, allergies, medications, pertinent medical history, last food or drink and events leading up to the incident.
- Conduct a head-to-toe check: Check head and neck, shoulders, chest and abdomen, hips, legs and feet, arms and hands for signs of injury.
- Provide care consistent with knowledge and training according to the conditions you find.
3. If the Person Appears Unresponsive
Shout to get the person’s attention, using the person’s name if it is known. If there is no response, tap the person’s shoulder (if the person is an adult or child) or the bottom of the person’s foot (if the person is an infant) and shout again, while checking for normal breathing. Check for Responsiveness and breathing for no more than 5-10 seconds.
4. If the Person is Breathing
Send someone to call 911 or the designated emergency number and obtain an AED and first aid kit.
- Proceed with gathering information from bystanders using the SAMPLE2 questions
- Conduct a head-to-toe check.
- Roll the person onto his or her side into a recovery position if there are no obvious signs of injury.
5. If the Person is NOT Breathing
- Send someone to call 911 or the designated emergency number and obtain an AED and first aid kit.
- Ensure that the person is face-up on a firm, flat surface such as the floor or ground.
- Begin CPR (starting with compressions) or use an AED if one is immediately available
- Continue administering CPR until the person exhibits signs of life, such as breathing, an AED becomes
available, or EMS or trained medical responders arrive on scene.
Note: End CPR if the scene becomes unsafe or you cannot continue due to exhaustion.
CPR/AED Instructions
The 2017 American Heart Association Guideline Updates3 continue to recommend that lay rescuers trained in CPR give chest compressions and rescue breaths at a ratio of 30:2 for adults in cardiac arrest. The same 30:2 ratio is advised for pediatric cardiac arrest4; but if a second rescuer can assist, a 15:2 ratio should be followed.
Basic First Aid Reference Table567
| Control bleeding | Put on gloves. Cover the wound with a dressing, and press firmly against the wound (direct pressure). Elevate the injured area above the level of the heart if you do not suspect that the victim has a broken bone. Cover the dressing with a bandage. If the bleeding does not stop, apply additional dressings and bandages, and use a pressure point to squeeze the artery against the bone. Provide care for shock. |
| Care for Shock | Keep the victim from getting chilled or overheated. Elevate the legs about 12 inches (if broken bones are not suspected). Do not give food or drink to the victim. |
| Burns | Reduce pain by gently cooling the burn. Pour large amounts of water over the burned area. Cover the burn with dry, clean dressings or cloth. |
| Muscles, bones and joint injuries | Rest the injured part. Apply ice or a cold pack to control swelling and reduce pain. Avoid any movement or activity that causes pain. If you must move the victim because the scene is becoming unsafe, try to immobilize the injured part to keep it from shifting. |
| Poisoning | Call the Poison Control Center (1-800-222-1222) and communicate what was swallowed and how much. Follow the directions given exactly. |
| Allergic reaction | Allergic reactions range from mild (e.g. hay fever) to severe (e.g. anaphylaxis). Anaphylaxis (an-a-fi-LAK-sis) is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, or medications. More specific response actions outlined below. |
| Heat Illness | Heat exhaustion is the most common type of heat illness. Move to a cool, shaded place; hydrate with cool water. If no improvement, call 911 and seek medical help. Do not return to work in the sun. Heat exhaustion can progress to life-threatening heat stroke. More specific response actions outlined below. |
| Hypothermia | Move the victim into a warm room or shelter and remove wet clothing. Warm the center of their body first-chest, neck, head, and groin- under loose, dry layers of blankets, clothing, towels, or sheets. Warm beverages may help increase the body temperature, but do not give alcoholic beverages. Do not try to give beverages to an unconscious person. After their body temperature has increased, keep the victim dry and wrapped in a warm blanket, including the head and neck. If victim has no pulse, begin cardiopulmonary resuscitation (CPR). |
| Frostbite | Get into a warm room or shelter as soon as possible. Unless absolutely necessary, do not walk on frostbitten feet or toes-this increases the damage. Immerse the affected area in warm-not hot-water (the temperature should be comfortable to the touch for unaffected parts of the body). Warm the affected area using body heat; for example, the heat of an armpit can be used to warm frostbitten fingers. Do not rub or massage the frostbitten area; doing so may cause more damage. Do not use a heating pad, heat lamp, or the heat of a stove, fireplace, or radiator for warming. Affected areas are numb and can be easily burned. |
| Other Environmental Injuries |
Signs/symptoms and treatment are described thoroughly in the reference NOLS Wilderness Medicine 6th edition by Tod Schimelpfenig (2016) for altitude sickness, lightning, stings and bites, and cold water immersion. As these types of injuries occur infrequently, it’s important to carry a wilderness medicine reference with you; a condensed field version is typically provided during wilderness first aid training. |
Anaphylaxis
Allergic reactions range from mild (e.g. hay fever) to severe (e.g. anaphylaxis). Anaphylaxis (an-a-fi-LAK-sis) is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, or medications. Symptoms may develop immediately, rapidly progress over minutes, or develop slowly over hours. Anaphylaxis requires immediate medical treatment, including a prompt injection of epinephrine and a trip to a hospital emergency room. If it isn’t treated properly, anaphylaxis can be fatal.
Note: Epinephrine requires a medical prescription. Individuals with known allergy may carry their own epinephrine auto-injector, typically in a two-pack. California law does allow trained “lay rescuers” to carry epinephrine auto-injectors in first aid supplies and administer to a person experiencing anaphylaxis, but the “lay rescuer” must have a current Epinephrine Certification Card issued by the State of California Emergency Medical Services Authority and meet all other requirements of UC’s Epinephrine Auto-Injector Program. In all situations when an epinephrine auto-injector is administered, the patient must immediately be taken to an emergency room for medical evaluation.
Signs and Symptoms of Anaphylaxis may include8:
- Red rash, with hives / welts, that is usually itchy*
- Swollen throat or swollen areas of the body
- Wheezing
- Passing out
- Chest tightness
- Difficulty breathing, cough
- Hoarse voice
- Difficulty swallowing
- Vomiting
- Diarrhea
- Stomach cramping
- Pale or red color to the face and body
- Feeling of impending doom
First Aid Response to Treat Anaphylaxis
- Contact EMS by calling 911
- If possible, separate the patient from the allergen
- If the patient can speak and swallow, give oral antihistamines (adult dose = 25mg -50mg of Diphenhydramine hydrochloride every 4-6 hours) and continue until EMS takes responsibility for care.
- Inject epinephrine via auto-injector (adult dose = 0.3mg intramuscular into the upper thigh) for:
- any airway swelling (lips, tongue, uvula, voice changes)
- large areas of swelling
- respiratory compromise or shock
- If severe allergic reaction continues, administer a second dose of epinephrine via auto-injector.
- Evacuate to seek emergency medical care for the patient immediately.
Directions for Use of Auto-injectors
- Never put thumbs, fingers, or hands over the tip of the auto-injector.
- Wear gloves.
- Inform the patient of your actions and obtain consent from the patient before administering epinephrine. If unresponsive, implied consent is acceptable in a life-threatening situation.
- Form a fist around the auto-injector.
- With your other hand, remove the safety-caps.
- Jab the auto-injector firmly into patient’s outer thigh so that the auto-injector is perpendicular to the thigh.
- Hold the auto-injector firmly in the thigh for 10 seconds to allow time for the medication to disperse.
- Remove the auto-injector, and then massage the injection area for several seconds.
- Store used auto-injectors in their carrying case, inserting them carefully and needle-first into the labeled side.
- Continuously monitor the patient and immediately seek emergency medical care.
- As needed, a second dose of epinephrine may be administered 15 minutes after the initial dose.
Additional Guidelines for Auto-injectors
- Become familiar with the auto-injector before the need to use it arises; know where it is physically located.
- Epinephrine should be administered at the first sign of anaphylaxis.
- If a participant or coworker is experiencing signs/symptoms of anaphylaxis, and does not have a prescription for epinephrine, only trained staff with an Epinephrine Certificate Card may administer auto-injector(s) as described in their emergency action plan.
- ANY administration of epinephrine, intentional or accidental, initiates an evacuation to emergency medical care.
- Protect auto-injectors from heat/light and do not refrigerate.
- Replace and do not use auto-injectors if solution is discolored, cloudy, or contains particles.
Heat Illness
| First Aid–Signs & Symptoms of Heat Illness | ||
| Signs & Symptoms | Treatment | Treatment |
|
HEAT EXHAUSTION
|
|
Heat exhaustion is the most common type of heat illness. Initiate treatment. If no improvement, call 911 and seek medical help. Do not return to work in the sun. Heat exhaustion can progress to heat stroke. |
|
HEAT STROKE
|
|
Call 911 or seek medical help immediately. Heat stroke is a life threatening medical emergency. A victim can die within minutes if not properly treated. Efforts to reduce body temperature must begin immediately! |
Psychological First Aid
Psychological First Aid9 is basic, pragmatic support for victims, survivors, and responders who exhibit acute stress response following trauma, violence, or disasters. The intent is to recreate a sense of safety, ensure basic physical needs are met, and protect the patient from additional harm:
- Help people meet basic needs for food, shelter, and first aid
- Offer accurate information about the situation and rescue efforts
- Give practical suggestions that steer people toward helping themselves
- Help people contact friends and loved ones
- Direct people to support services.
Seeking Medical Care or Other Support
Campus Services
Many UC campuses offer urgent care, emergency services, occupational health and travel clinics, confidential care advocates, counseling, and after hours advice nurse consultations or referrals. Note these numbers and resources in advance in a written field safety plan carried in the field (see appendix for campus-specific contact numbers).
During Travel
Directions and contact information for nearby medical services should be identified in advance and included in
your field safety plan. For international travel, the US State Department and embassy websites provide guidance on finding a doctor or hospital while abroad10.
For emergency assistance while traveling, contact the toll-free 24/7 number provided on your registration card for our UC travel insurance provider.
You may register travel via the UC Away web portal https://ehs.ucop.edu/away.
Incident Reporting
Immediately report all work-related fatalities, catastrophes, serious injuries or illnesses to your supervisor and campus department. Supervisors/departments are responsible for promptly reporting incidents to EH&S or Risk Services and completing incident report forms. Ideally, specific emergency contact numbers and incident reporting procedures are clearly outlined in written field safety plans carried in the field. Consider carrying appropriate incident report forms and a copy of your field safety plan in your first aid kit.
Lessons Learned
By reporting and reviewing incidents among field teams, departments, and with campus staff, lessons learned can benefit a broader group and help improve our operations. We all recognize that injuries happen when working outdoors in uncontrolled environments but want to strive toward being prepared, making safe decisions in the field, and minimizing the negative consequences when incidents occur.
Your department safety committee or coordinator, EH&S staff, research oversight committees, or other personnel on campus may be involved in accident investigation and review of lessons learned.
Near-Misses and Improvements
Ideally, all field projects and courses include an opportunity for debrief, even when no unintended incidents occur. Discussion of project goals, challenges, and logistics can often identify clear improvements and planning needs for subsequent fieldwork.
