First aid means just that, the first aid. Your crew members are the first responders to an incident and they must have the training and supplies to handle minor injuries that can be managed on-site to severe injuries that must be managed until emergency medical services arrive. First aid training will help them react appropriately in a calm, efficient manner rather than waste valuable minutes panicking about what to do. Knowing what first aid supplies they have available and understanding the when, how, and why to use them is a key element of preparation.
While at least two workers on every crew must be trained in first aid/CPR, every field employee should be trained for a situation where they might need to apply first aid treatments. A well-stocked and ready-to-use first aid kit is one of the best ways to prepare for emergencies. Having access to a first aid kit doesn’t just come in handy for minor injuries, it can be the difference in saving someone’s life.
A first aid kit must be with every field crew but what must be in the first aid kit? Too many crews have never opened their first aid kit. It remains in their truck, only to be opened when an emergency arises. And how many kits in rusty metal boxes have remained unopened for years? There are several serious issues with neglecting first aid kits.
First, every first aid kit should be inspected at least monthly, better weekly, to be sure they contain the proper supplies, and are in adequate quantities, to respond to an incident. A label on the cover of the kit can be used to note the inspection date. Another common practice is to clip the kit latch with a plastic tie. If the tie is cut, the inspector knows someone got into the kit and pulls some of the supplies out since the last inspection.
Second, everything expires at some point and periodically even unused supplies must be discarded and replaced. Third, just as our Z133 Safety Requirements for Arboricultural Operations updates and changes safety procedures, the Z308.1 Minimum Requirements for First Aid Kits updates first aid kit requirements.
OSHA does not set first aid kit requirements for arboricultural operations. However, they do require that every employer stock first aid kits that reflect the hazards and the possible first aid needs for the job. The Z308.1 reflects this requirement by dividing first aid kits into two broad categories; Class A: low-risk, general workplace, and Class B: high-risk, industrial workplace. The Class B kits have a broader range of supplies and quantities to deal with the injuries that may occur in the tree worker’s high-risk work environment. Here is an inside look at the first aid kit that tree crews must carry with them daily.
Anatomy of your first aid kit
Each Class B first aid kit contains supplies to address five common first aid needs; 1) bleeding, 2) musculoskeletal injuries, 3) burns, 4) eye injuries and 5) CPR. The kit must also include a first aid guide. An important note: many first aid supplies, such as a tourniquet, require training. This is why it’s not enough to have the kit, at least two crew members should know how to properly use everything in the kit!
Here is the basic anatomy of a Class B first aid kit.
Dressings and bandages for managing bleeding
Dressings are the absorption material that manages bleeding and protects the wound. Bandages are what hold them in place and apply pressure. These are the most common items found in first aid kits. Adhesive bandages, 1-inch by 3-inches (2.5 x 7.5 cm), for the minor cuts and scrapes that may occur in any workplace environment to sterile pads, 3-inches by 3-inches (7.5 x 7.5 cm), and trauma pads, 5-inches by 9-inches (12.7 x 22.9 cm), for managing severe bleeding.
A specific requirement of Class B first aid kits is a tourniquet (at least 1-inch, 2.5 cm, wide), to manage bleeding from amputations or deep lacerations.
Antiseptic and antibiotic substances are also included in the kit to protect the wound and reduce infection. Examination gloves are also part of the kit to protect the first aid provider. While not specified, the preferred material for the gloves is nitrile as some people are allergic to latex and vinyl does not provide sufficient protection from blood-borne pathogens. An item missing from the list for a Class B first aid kit but must be included is a bag specifically for bio-waste, the contaminated gloves, and labeled for this use.
Splints for possible fractures
First, treat any dislocation, swelling, or other presentation of a musculoskeletal injury as a fracture until EMS arrives. This means splinting in a position of comfort for the injured worker. A split is another specific requirement for a Class B first aid kit, at least 4-inches wide by 24-inches long (10.2 x 61 cm). The splinting material is not specified but structural aluminum malleable (SAM) split is a common device. Triangular bandages, 40-inches, by 40-inches by 56-inches (101 x 101 x 142 cm) are used to hold the split in place.
The kits should also have roller bandages in two sizes, 2-inches by 4-yards (5 cm x 3.66 m) and 4-inches by 4-yards (10 cm x 3.66-yards) that are useful in supporting sprains and strains. A cold pack to reduce swelling for musculoskeletal injuries is also part of the first aid kit.
Burn dressings
Burns are common injuries to tree workers and range from friction ‘burns’ from running ropes to electrical burns. The first aid kit must contain burn gel that can be easily washed off at the hospital. A blanket can be used to protect open burn wounds from infection and keep the burned worker from losing body heat from larger, severe burns. The material must not contain fibers that can stick to the wounds. A mylar space blanket is preferred. This blanket can be used for keeping any patient warm, regardless of their injuries.
Eye injuries
Medical supplies for eye injuries must include an eye wash and eye covering with an attachment. The sterile eye wash is used to remove debris and chemicals from the eye. The eye covering is for protecting the injured eye from further injury. There are at least two coverings in the kit. One can be placed on the injured eye, the other as a covering on the uninjured eye. Covering the uninjured eye keep the injured eye from tracking its movements.
CPR supplies
Cardiopulmonary resuscitation is not a common medical first aid emergency among tree workers but still, CPR skills are essential to know. While “hands only” compression CPR are commonly practiced in training, knowing how to do breaths is important. Compressions will keep oxygenated blood moving but eventually – four minutes or so – the blood will have little oxygen and it must be replenished by breaths. Every first aid kit must have a breathing barrier for the CPR provider.
First aid guide
A first aid guide must be included in the kit that covers the basic injury care from bruises and insect stings to serious injuries like breathing emergencies and bone and joint injuries. It is strongly recommended that all employees review the guide as part of their first aid/CPR training.
Miscellaneous supplies
To assist in applying first aid creams and wound care, each kit should contain disposable cotton-tipped applicators, a set of plastic tweezers to remove debris and insect stingers from the skin, and safety pins to hold roller bandages. A roll of adhesive tape is also helpful.
Epi-pens are not part of the first aid kits as these are prescribed medical supplies and are not intended for use by anyone other than the person identified on the prescription. However, any worker who has been prescribed epi-pens should have the crew practice with the dummy so they know how to use them. Also, epi-pens are provided as a set and both should be carried. They come in a set for a reason. Sometimes that second pen is needed within minutes after the first.
Distress items
These are items not identified in Class B kits but may be useful to carry. These items can be used for distress and are often overlooked. Each kit should also include a “Call 911” flag, a rain poncho, and a light stick. If an emergency arises, this equipment can be used to direct emergency professionals to the location of the injured worker.
Keep it stocked, keep it handy, and use it
As soon as any of the above items are utilized, restock. That way the crew will never be without the supplies needed and in the quantities required. First aid kits are only useful if they are easily retrieved and stocked with the necessary items to treat injuries. Keep the kit handy in the vehicle and make sure that used items are always replaced. As a follow-up, you should document the treatment with an incident report.
