OPITO Medical Emergency Response Requirements

OPITO Medical Emergency Response Requirements © OPITO The content of this document was developed and reviewed in 2015 by OPITO to improve Emergency Response Arrangements based on accepted industry best practices. Guidance

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© OPITO All rights reserved. No part of this publication may be reproduced, stored in a retrieval or information storage system, or transmitted, in any form or by any means, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. AMENDMENTS AMENDMENT & DATE Revision 0 released January 2016

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CHANGES MADE BY

CHECKED BY

APPROVED BY

Melissa Foo

Industry and OPITO Approvals Department

Peter Lammiman

Any amendments made to this document by OPITO will be recorded above.

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OPITO Medical Emergency Response Requirements © OPITO CONTENTS INTRODUCTION ...................................................................................................................................... 4 A.1 MEDICAL EMERGENCY RESPONSE REQUIREMENTS HIERARCHY ............................................................... 5 A.2 MEDICAL EMERGENCY RESPONSE PEOPLE AND COMPETENCE ................................................................ 5 A.3 TIER 0: ALL STAFF ......................................................................................................................... 5 A.3.1 Tier 1: Designated First Aider (DFA) .................................................................................. 6 A.3.2 Tier 2: On-site MER Professional ....................................................................................... 7 A.4 MEDICAL EQUIPMENT, SUPPLIES AND FACILITIES ................................................................................. 8 A.4.1 Tier 1: First Aid Equipment ................................................................................................ 9 A.4.2 Tier 2: MER Equipment ....................................................................................................10 A.5 MER MITIGATING MEASURES........................................................................................................11 A.6 ASSURANCE AND MAINTAINING EMERGENCY RESPONSE PREPAREDNESS .................................................11 A.7 MINDSET AND CULTURE................................................................................................................12 APPENDIX A: EXAMPLE OF AN MER PLAN ..............................................................................................13 APPENDIX B: MEDICAL EMERGENCY RESOURCE REQUIREMENTS GUIDANCE ........................................14 APPENDIX C: EXAMPLE MEDICAL EMERGENCY GAP ANALYSIS TOOL.....................................................15 APPENDIX D: EXAMPLE MER RISK ASSESSMENT TOOL ..........................................................................16 APPENDIX E: SAMPLE MEDICAL SCREENING AND SELF-DECLARATION OF FITNESS FOR ATTENDING OPITO …… TRAINING FORM ...................................................................................................................17 APPENDIX F: INCIDENT DEFINITIONS .....................................................................................................20

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OPITO Medical Emergency Response Requirements © OPITO

INTRODUCTION The safety and wellbeing of all delegates undergoing training is paramount and OPITO’s number one priority at all times. This document has been developed in consultation with subject matter experts to provide clear Medical Emergency Response (MER) expectations and requirements for OPITO Approved Training/Assessment Centres to ensure adequate provisions can be made, exercised, recorded, maintained and audited. The medical emergency response requirements set out in this document is derived from industry’s best practices and is based on a tiered time-based response. It details expectations on maximum response times, minimum equipment levels and access to specified medical personnel and facilities in an event of a medical emergency. It also identifies roles, designations, responsibilities and competence of medical emergency response staff. All highlighted area’s indicate OPITO audit requirements, these requirements will be used by OPITO auditors during audit of training providers. Risk Assessment Factors that may have a direct impact on the likelihood and severity of injury or illness, as well as the level of MER resources needed on site are determined by the nature of work activities performed at the site, the number of people on site, transportation options, availability and infrastructure, geography, climate, security, characteristics of the working population (e.g. age profile, gender mix, migrant status, etc), local health facilities’ capability and location. Certain training activities can be arduous by nature requiring high levels of physical exertion and may sometimes induce mental stress on the individual. Not all exercises are without risk (for example, swimming pool and firefighting practical exercises). Some examples of risks associated with training activities may include the risk of a cardiac event or stroke due to physical exertion, drowning, burns and trauma due to injury, slips, trips and falls. Prevention A critical first barrier in the prevention of incidents is to ensure care for delegate’s wellbeing. Delegates must be made aware of the physical nature of this training; it must be ensured that relevant fitness to work, associated with in-company roles and/or fitness to train assessments are required to be up to date at the time of training. Information covering the pre-course requirements for OPITO training is covered in number of OPITO documents, these include sections within the Approval Guide, e.g. criteria 4.1 (joining instructions), section in OPITO standards e.g. A.3 Physical and Stressful Demands and D.1 Joining Instructions within the relevant OPITO standards – Appendix E contains non exhaustive advice to ensure medical screening forms provided by OPITO Approved Training/Assessment Centres are consistent.

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OPITO Medical Emergency Response Requirements © OPITO

A.1

Medical Emergency Response Requirements Hierarchy

A Medical Emergency Response Plan (Appendix A) sets the expectation of the actions that will take place in response to emergencies, and will be based on the Training Providers site risk assessment. A tiered time-based response (Table 1) forms a suitable basis for MER response at Training Provider sites. Appendix A, B, C and D may be used as an aide to make risk based site specific MER Plans. Tier

Time-based response Matrix

Tier 0 Tier 1

Initiation of intervention – call for help Provide first aid treatment including, Basic Life Support (BLS), defibrillation and oxygen by a designated (and competent) first aider within 4 minutes.

Tier 2

Provide assessment and stabilisation by a registered MER Professional within 1 hour (within 20 minutes if high risk activity is indicated)*.

Tier 3

Provide admission to and care at the nearest Hospital Emergency Room within 4 hours (within 1 hour if high risk activity is indicated)*. This includes adequate means of transportation by ambulance with competent staff (Tier 2 level) and equipment. Table 1. MER Tier based response time table

*High Risk activity includes all practical activities covering any practical exercises where there is a risk of serious injury including all in and on water and practical firefighting course elements. Based on the Training Centre and training locations e.g. the geographical location may impact on the risk assessment therefore the tiered requirement would be extended to other standards e.g. Competence Assessor, H2S, Rigging and Slinging. Audit Requirement – MER A.1 Tier Time based responses are indicated in the risk assessments as per the matrix

A.2

Medical Emergency Response People and Competence

The Training Centre shall develop an annual training matrix/plan for all individuals involved in incident management and Medical Emergency Response, this plan maybe be part of other training plans for individuals, the plan will identify all required training and necessary (refresher) training. The completion of the trainings and the necessary competency certifications will be maintained on record. Audit Requirement – MER A.2 Annual Training Matrix/Plans are current and available for all relevant MER staff, this may be included in the Training Providers overall training plan.

A.3

Tier 0: All staff

Tier 0 includes all training centre staff. Review of incidents has shown that failures in first response can cause significant delay. It is known that to be effective first aid and defibrillation has to be delivered as quickly as possible. An important step to achieving an effective response is to ensure everyone knows Revision 0 (January 2016)

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OPITO Medical Emergency Response Requirements © OPITO what to deal with an emergency. Tier 0 training can take place at site induction, and training records are to be maintained to demonstrate that Tier 0 training has taken place and refreshed as required, Tier 0 training would include the following: Frequently mnemonics are to be used to assist in memorising the type of information that may need be passed internally or externally and may include but not be limited to the following: a) b) c) d) e) f) g) h)

How to raise the Alarm, Scene Safety, site location which can include the availability of GPS coordinates Nature of incident/emergency Casualty assessment (TRIAGE – basic initial diagnosis) basic dos and don’ts, assure/reassure comfort, care of casualty, keep warm/shade, do not move etc. Site specific hazards (Fire, Chemicals, etc.) Access Routes (e.g. specify which gate to use if multiple entrances and notify security) Number of Casualties, action taken Recognition of stress in delegates Type of Emergency services already present or required

Some basic first aid e.g. the First Aid section of the BOSIET standard is also recommended for training provider staff. Audit Requirement – A.3 Staff training covering Tier 0 (A.3 a – h) has been conducted, training records are available and current.

A.3.1 Tier 1: Designated First Aider (DFA) Designated First aiders are the first MER team member providing support at a scene of an incident. DFA training must include the following: a) b) c) d) e) f)

Scene assessment and safety Life Support to include CPR and AED Airway management (head tilt, chin lift) Basic First Aid Management (of burns and minor injuries) Initial treatment of common medical emergencies Administering O2 using appropriate O2 equipment

In order to avoid DFA competence decay, DFA competence is to be maintained through ongoing skills maintenance training. These are commonly implemented on 3-monthly cycles by informal practical training sessions at the workplace, and facilitated by a Tier 2 MER Professional. Each session would generally last about 2-3 hours. A listing of approved DFA courses can be found on most National Health and Safety Authority websites, good examples of approved DFA courses are Red Cross/Red Crescent/St. John Ambulance/American Heart Association. Audit Requirement - A.3.1.1 Designated First Aiders (DFA) hold valid DFA qualification as listed on National websites, or qualified with Red Cross/Red Crescent/St John Ambulance/American Heart Foundation, in addition there is evidence that items A3.1 a – f have been covered. Revision 0 (January 2016)

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OPITO Medical Emergency Response Requirements © OPITO Audit Requirement - A.3.1.2 Records of Informal practical training sessions is conducted at the workplace facilitated by a Tier 2 MER Professional on a 3 monthly cycle.

A.3.2 Tier 2: On-site MER Professional Although the stated response time for Tier 2 is 1 hour, if the course programme includes activities with a High Risk of serious injury, the required Medical response time would be reduced to 20 minutes as per Tier Time based response matrix and may require Tier 2 MER staff, equipment and facilities on site. Tier 2 MER Professionals are registered nurses, emergency medical technicians, paramedics, nurse practitioners, physician assistants or physicians. They are responsible for providing assessment and stabilisation of ill or injured persons. 1) Tier 2 MER Professional Capabilities A Tier 2 Medical Professional is at minimum expected to recognize, assess and stabilize a patient showing signs of cardiac arrest, stroke, drowning, burns and trauma, and be proficient in the following: a) Competence application of CPR and AED usage b) Advanced airway management – insertion of oro/nasopharyngeal airway and bag/mask ventilation c) Establishing IV/IO access d) Starting IV/IO fluids e) Administering IV/IO adrenaline f) Quick neurological assessment using GCS score g) Treat hypovolemia, hypoxia, hypothermia, tension pneumothorax and pulmonary and coronary thrombosis 2) All Tier 2 MER Professionals must be in possession of a valid international medical qualification which will include Basic Life Support (BLS) and Advanced Life/Cardiac Support (ALS/ACLS) or equivalent e.g. a) Pre-Hospital Emergency Care Course (PHECC), b) Pre-Hospital Trauma Life Support (PHTLS) c) Advanced Trauma Life Support (ATLS) These courses are good examples of courses that include Advanced Life Support training. Audit Requirement – A.3.2.1 MER Professionals are in possession of a valid international medical qualification which includes Basic Life Support (BLS) and Advanced Life/Cardiac Support (ALS/ACLS) or equivalent. 3) There must be medical protocols for the training centre Tier 2 Medical Professionals to use (as a minimum protocols covering drowning, cardiac arrest, respiratory arrest, burns and other serious injury scenarios as identified in training provider risk assessment), these protocols must be supervised and audited by a supervising medical professional e.g. a Doctor yearly, aid memoir posters would be available to act as prompts when dealing with situations requiring specific protocol Revision 0 (January 2016)

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OPITO Medical Emergency Response Requirements © OPITO response. All Tier 2 Medical Emergency professionals will have access to a senior supervising medical professional e.g. a doctor for case advice and discussion at all times when training/assessment is taking place. (See MER mitigation measures (section 5) Audit Requirement – A.3.2.2 Medical Protocols are available for Tier 2 Medical Professionals covering applicable serious injury scenario’s as identified in training provider risk assessment Audit Requirement – A.3.2.3 Yearly protocol audit records from the Supervising Professional e.g. a Doctor are available and current Audit Requirement – A.3.2.4 MER Tier 2 Medical Professionals have access to supervising medical doctor during training. 4) Skills Maintenance of Tier 2 MER Professional: In addition to renewal of Certification (generally valid for 3 years), a 6 -12 week hands-on training/refresher in an ambulance/emergency room, trauma unit or similar setting would be required, unless skills maintenance have been maintained on a continual basis (e.g. MER Professional works part-time in one the aforementioned settings). Tier 2 MER Professional Refresher Training Components and Skills will include: a) Basic Life Support skills b) Recognition, assessment, stabilisation and management of the deteriorating patient using a structured ABCDE* approach c) Advanced Airway management skills (use of oro/naso pharyngeal airway to ventilate/oxygenate) d) Cardiac and Respiratory arrest management (including IV/IO access, medication, ECG) *ABCDE – Airway, Breathing, Circulation, Disability, Exposure Audit Requirement – A.3.2.5 Tier 2 MER Professional certification is available and current, and is maintained as indicated in section A.3.2 (4)

A.4

Medical Equipment, Supplies and Facilities

There will be sufficient suitable medical equipment available at all points of use as identified in the risk assessment e.g. all high risk areas – practical firefighting sites, and practical water based activities (refer Appendix C). The equipment shall be inspected and maintained in predetermined intervals to ensure correction functioning at the point of use. The intervals will meet, as a minimum, the respective manufacturer specifications and be operated and used in the respective regular drill exercises. Audit Requirement – A.4.1 The Risk Assessment shall identify the location, type and quantity of medical equipment available. Revision 0 (January 2016)

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OPITO Medical Emergency Response Requirements © OPITO Audit Requirement – A.4.2 The medical equipment is maintained as per manufacturers specification, maintenance records are available. A current site layout, which will include as a minimum the location of all emergency response equipment appropriate to the risks identified in the risk assessments e.g. O2 administration and AED equipment is located next to high risk areas e.g. a pool side, the layout will be explained and be visible to delegates. Audit Requirement – A.4.3 The training site layout includes the locations of emergency response equipment, the layout is explained and visible to delegates at the training location. Proximity to the nearest hospital emergency room is an important factor to consider in medical emergency response planning, as this will influence the level of training and competence required by medical emergency response staff, as per matrix contained within section A.1 Training Provider facilities must ensure: 1) There is an adequate external Tier 3 facility (Hospital Emergency Room) which can meet the Tier 2 response time, this includes adequate means of transportation (competent ambulance staff, equipment and capabilities). 2) In the absence of suitable external Tier 3 facilities within the Tier 2 response time, Training Providers must provide their own, competent Tier 2 MER Professionals, transportation and equipment. Audit Requirement – A.4.4 Training Providers have suitable external Tier 3 facilities within the Tier 2 response time. Audit Requirement – A.4.5 Competent Tier 2 MER Professionals, transportation and equipment are available where Tier 3 facilities are not available onsite, to ensure delegate wellbeing enroute to Tier 3 facilities.

A.4.1 Tier 1: First Aid Equipment First Aid Equipment is inspected and maintained, the maintenance is carried out by an individual or company authorised and competent to conduct the maintenance. First Aid equipment is managed and used by Designated First Aiders (DFA). Equipment must include the following: First Aid Equipment a) Automated external defibrillator (AED) b) Barrier devices and protection (i.e. pocket mask, rubber gloves, protective goggles, plastic apron, biohazard waste bag) c) Vital signs equipment (i.e. automatic blood pressure measurement device, digital thermometer) d) Bandages (i.e. triangular, elastic, roller). e) Dressings (i.e. gauze pads, burn dressings, multi-trauma dressings, eye pads, antiseptic wash, adhesive dressings) f) Foil blanket (adult size) Revision 0 (January 2016)

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OPITO Medical Emergency Response Requirements © OPITO g) h) i) j) k) l)

Splints (e.g. SAM splints) Cold pack compress Miscellaneous: adhesive tape, cotton buds, safety pins, pen, paper, scissors Guides: Basic life support (BLS) algorithm card, first aid pocketbook Inventory of box contents Oxygen

Audit Requirement – A.4.1.1 Sufficient First Aid Equipment is available and includes items listed A.4.1 a – l

A.4.2 Tier 2: MER Equipment MER Equipment is inspected and maintained, the maintenance is carried out by an individual authorised and competent to conduct the maintenance. MER equipment is managed and used by Tier 2 MER Professional and must include the following: Tier 2 Medical Equipment a) First Aid bag (see contents list above) b) Laryngeal mask or similar c) Oro and nasopharyngeal airways d) IV cannulas e) IO cannulas f) Infusion sets and saline g) Medication for pain relief, resuscitation h) Suction device i) 12 lead ECG j) The non-invasive blood pressure (NIBP) monitoring system k) Monitoring system for Oxygen saturation - SaO2 l) Blood sugar measurement m) Pupil torch n) Current Medical Protocols

Audit Requirement – A.4.2.1 Sufficient Medical Equipment is available and includes items listed A.4.2 a – n Additional equipment and supplies (based on the training provider risk assessment) may be needed for specific hazards or specific environments, these may include diving operations. In addition, for Tier 1 a ‘designated room’ or Tier 2 ‘designated medical room’ is required to enable stabilization prior transportation to hospital, or stabilization on site prior to re-joining training, Audit Requirement – A.4.2.2 A suitable ‘designated room’ or ‘designated medical room’ is available during training activities The link to the type of medical material like protocols for staff to use can be found here: https://www.acls.net/aclsalg.htm. This is to ensure that personnel have access to current medical protocols, for example on managing stroke, cardiac and respiratory arrest. Protocols from other Revision 0 (January 2016)

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OPITO Medical Emergency Response Requirements © OPITO equivalent internationally recognised organisations are acceptable. equivalent internationally recognised organisations are acceptable.

A.5

MER Mitigating Measures

The following are examples of suitable additional mitigation measures to ensure that MER risks are kept as low as reasonably practicable in particular these measures would be applied in more remote locations, these measures are provided to assist training providers in identifying the most effective risk mitigation options, it is expected these options would be incorporated into risk assessments where applicable:

Risk Mitigation Measures Enhance Tier 1 and Tier 2 competency by specifying higher requirements for skills and experience e.g. Oxygen Administration for DFAs. b) Specify that all Tier 2 MER Professionals will be proficient in managing risks identified in the site risk assessment (e.g. risk of cardiac arrest, stroke, drowning, burns, trauma, heat exhaustions etc.) c) Increase number of Tier 2 MER Professionals d) Shortening of Tier response times

1. Additional MER Staff resources and capability

a)

2. Equipment/Supplies

a)

Additional medical equipment and supplies, in order to enhance the Training Facilities ability to manage challenging cases on-site (e.g. ECG)

3. Support and Telemedicine

a)

Implement a system for the site Tier 2 MER professional to access realtime specialist medical advice and instruction from emergency senior medical professionals (usually doctors) located at the nearest emergency room facility, via telecommunications and/or information technologies. For further info see the IRHC Guide (Institute for Remote Healthcare Guide).

4. Improved transportation

a) Put transportation on standby (e.g. Locate standby ambulance onsite) b) Use faster transportation (e.g. air transportation instead of ground transport)

A.6

Assurance and Maintaining Emergency Response Preparedness

The organisation’s Medical Emergency Response Plans and Procedures, shall be reviewed every three years and approved annually for accuracy, The MER plan will form the basis for regular effectiveness testing and scenario drills. The training provider will establish, maintain and execute a programme of exercises that tests their plans, procedures and scenarios.

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OPITO Medical Emergency Response Requirements © OPITO Audit Requirement A.6.1 – Medical Emergency Response Plans are reviewed every three years, and approved annually Realistic MER Tier 1 drills are to be conducted as a minimum quarterly. Where applicable, in and on water based activities Tier 1 drills are to include practicing casualty extraction, First Aid/BLS provision, basic oxygen therapy, CPR and defibrillator administration. Realistic Tier 2 drills of the Medical Emergency Response protocols will be carried out twice per year, and annually extended to include third party emergency services (such as ambulance and the nearest Tier 3 facility) to verify ongoing effectiveness. All records of emergency response drills and exercises are to be maintained, In general, each emergency effectiveness practice exercise would include the following; a) Test a particular emergency response scenario and be measured for its effectiveness b) Include the testing of notification and implementation of relevant procedures c) Test the internal emergency response team communications and communications between internal and external response services d) Record those personnel involved e) Record the emergency and medical equipment used f) Ensure the chronology of events and was recorded including actual response times g) Contain a conclusion in relation to the effectiveness of the response and include lessons learned. It is expected that any resultant learning will be applied to the relevant Emergency Response Plans and documents. Audit Requirement A.6.2 – Records are maintained of quarterly MER Tier 1 drills as per requirements contained within A.6. Where applicable, practicing casualty extraction, First Aid/BLS administration, basic oxygen therapy, CPR and defibrillator administration are to be included Audit Requirement A.6.3 - Records are maintained of bi annual MER Tier 2 drills as per requirements contained within A.6. Audit Requirement A.6.4 - Records are maintained of annual MER Tier 2 drills including Tier 3 third party emergency services as per requirements contained within A.6.

A.7

Mindset and Culture

Worksite cultures vary and demonstrating a strong Health and Safety mind-set is paramount to achieving a safe and healthy outcome. Medical Protocols, and Right and Duty to Stop Messaging e.g. posters will be clearly visible to all at the Training/Assessment Centre. Trainers will be aware of training centre specific hazards and health and safety risks. All trainers and medical emergency responders will be able to identify unsafe conditions or the first signs of stress/distress and will be empowered to intervene without hesitation at all times. Under no circumstances should training commence without appropriate medical emergency response capability being available onsite Revision 0 (January 2016)

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OPITO Medical Emergency Response Requirements © OPITO APPENDIX A: Example of an MER Plan

Tier 0: Immediate

Incident occurs Bystander   

Assess scene and casualty Make the area safe Notify Site Emergency Coordination Centre (ECC)

ECC Notify and Dispatch Designated First Aiders

Notify:    

Incident location Number of personnel injured Nature of injury/illness Incident contained or escalating

 

Treat casualty on-site designated room Notify ECC: De-escalate

 

Treat casualty on-site Notify ECC: De-escalate

Tier 1: < 4 minutes

DFA   

Obtain first aid bag (with AED) Assess casualty Provide Basic Life Support (BLS) / First Aid/Oxygen

Tier 2 activation required?



Activate Tier 2 Notify Site Emergency Coordination Centre (ECC)

ECC Dispatch Tier 2 Medical Professional

Tier 3: