On-the-Job Emergencies
Every concrete company should have its own safety guidelines and training to ensure the health and safety of its operators and employees on the jobsite. These should include written policies and procedures, safety precautions, training and an emergency plan. Since the risk of injury is high in the construction industry, it is vital that companies train employees to reduce the risk of injury. However, accidents and emergencies do happen, and often do not occur as a direct result of an incident on the job. Some health emergencies can occur without warning or provocation and require immediate attention. These types of emergencies are often not covered in company safety guidelines, but should be addressed, as employees equipped with this knowledge may be able to save a co-worker’s life.
Most common medical emergencies may not be caused by an incident on the job, but as the result of a pre-existing, possibly unknown condition. These medical emergencies include, but are not limited to: heart attack (myocardial infarction), stroke, asthma attack, diabetic shock, epileptic seizure and appendicitis. Other medical emergencies that could be triggered by worksite conditions include, but are not limited to: hyperthermia, hypothermia and concussions. The following section will discuss each of these conditions, how to identify them and what proper treatment can be given by other employees.
Heart Attack (Myocardial Infarction): Heart attacks are caused by a blockage of the heart’s coronary arteries (vessels that carry blood to the heart muscle itself), causing a depletion of oxygen to the cardiac muscle, eventually resulting in necrosis (permanent tissue damage). Symptoms include intense chest pain, possibly radiating to the jaw, left shoulder and arm, difficulty breathing, profuse sweating, nausea, vomiting, cyanosis (bluish skin color), shallow breathing and a rapid, irregular pulse. Immediate action is required; calling 911, or Emergency Medical Services (EMS) should be the first step. Next, continue to monitor the victim. Make sure the victim is in a stable environment and if cardiac arrest (complete stoppage of the heart) occurs, begin CPR if there is a trained person available. If an Automated External Defibrillator (AED) is available, use it as directed.
Stroke (Acute Cerebrovascular Attack): A stroke occurs when there is a rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of glucose and oxygen supply) caused by a blockage of a blood vessel in the brain, or hemorrhage. As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability of the stroke victim to understand or formulate speech, or inability to see one side of the visual field. Symptoms will usually have a rapid onset and may also include muscle weakness on one side of the body, altered mental state and balance and ambulation problems. EMS should be called immediately, and the person’s pulse and breathing should be monitored.
Asthma Attack: An asthma attack can be triggered by environmental conditions, such as allergens or foods, although some asthma attacks are not environmentally triggered. Often, a person with asthma will be aware of his or her condition and carry an inhaler, especially in moderate to severe cases. Symptoms of an asthma attack include dry wheezing, difficulty breathing─especially in exhaling─and chest tightness. In the case of an attack, the person should use their inhaler as soon as possible, and others should assist in keeping the victim calm and encouraging deep, rhythmic breathing. If the victim does not have an inhaler, or the attack cannot be controlled in a few minutes, call EMS.
Diabetic Shock: Diabetic shock is caused by insulin levels in the bloodstream that are either too low or too high. Symptoms vary depending on the condition, but can include a rapid or gradual onset, rapid pulse, labored breathing, altered mental state (confusion, stupor, irritability), warm, dry, red skin or cold, clammy and pale skin, intense thirst, nausea, vomiting, abdominal pain, dizziness, headache, profuse sweating, fainting and convulsions. Most people will be aware of a diabetic condition and be able to treat themselves before symptoms become too severe. In many cases, a small snack or juice will help stabilize blood sugar levels. Otherwise, EMS should be called.
Epileptic Seizure: An epileptic seizure can have no apparent cause and will most often occur without warning. As with diabetes and asthma, most epilepsy patients are aware of their condition. Most seizures will involve involuntary whole-body muscle contractions and loss of consciousness. Some however, may not involve a loss of muscle control, but complete unresponsiveness for an extended period of time. These seizures can last from less than a minute to several minutes. If a person is experiencing whole-body muscle contractions, remove any objects from the area that they could injure themselves on, DO NOT put anything in their mouth and if they begin to vomit, roll them onto their side and try to keep their airway open. In the case of this type of seizure, EMS should be called. If the seizure involves unresponsiveness and no muscle convulsions, EMS does not need to be called unless the condition does not improve after about 15 minutes.
Appendicitis: While appendicitis is most common in men under the age of 25, occasional cases in older individuals do occur. Symptoms include pain in the abdomen, tenderness and muscle rigidity in the lower right quadrant of the abdomen, possible nausea and vomiting. Symptoms will progressively worsen and may also include fever and rapid pulse. The person should be taken to the hospital for further evaluation, or EMS should be called.
Hyperthermia: Hyperthermia is caused by an increase in body temperature and the inability of the body to effectively cool itself. Large body mass, advanced age, poor conditioning level, poor hydration and some medications can predispose a person to hyperthermia. The condition is most common in hot, humid and sunny environments. Symptoms include excessive sweating, rapid and weak pulse, muscle cramps, dizziness, fainting, nausea and vomiting. In advanced cases, the person will become confused, stop sweating, have hot, red, dry skin, and dilated pupils. The person should be immediately moved to a cool location and body temperature must be lowered. This can be achieved by cold water immersion or cold, wet towels being placed on the head, neck, under the armpits, behind the knees and in the groin area. EMS should be called immediately. If possible, the person should be in a shaded area with a fan directed towards them. The priority in this situation is always to lower body temperature as soon as possible.
Hypothermia: Hypothermia is caused by a decrease in body temperature. The condition is most common in cold, damp and windy environments or by immersion in cold water. Symptoms include a slow, weak pulse, dilated pupils, shallow, irregular breathing, shivering, motor impairment and decreased mental focus. In severe cases the person may have developed frostbite (tissue damage in the extremities) and a desire to sleep. Treatment includes moving the person to a warm environment, removing any wet clothing, and wrapping in a dry blanket. If re-warming is done with hot water, rapid changes in temperature should be avoided. The person should be gradually re-warmed to avoid burning the skin and causing other internal problems. If hypothermia or frostbite is moderate to severe, call EMS.
Concussion: Concussions are the result of damage to the brain tissue, due to trauma to the head, such as an object striking the head or a person falling and hitting their head on a hard surface. Symptoms include mental confusion, alteration of mental status, amnesia, slurred speech, incoordination or balance deficiencies and possibly loss of consciousness. These symptoms could last from a few minutes to an extended period of time exceeding several days, depending on the severity of the concussion. If the symptoms are not severe, there is no loss of consciousness and do not last more than a few minutes; the person usually does not need immediate medical attention. Symptoms lasting longer than 15 minutes or a loss of consciousness require medical attention. If a person loses consciousness or the symptoms do not resolve and begin to worsen, call EMS immediately.
If there is ever any doubt on the treatment of any of these conditions, it is better to be safe and call EMS. Every company should also have an Emergency Action Plan (EAP) in place, with details on how to contact emergency services, other important numbers to call and a chain of command─who else needs to be notified of the emergency? It would be beneficial to have at least one person in the company who is trained in CPR/AED and first aid. Having an AED on-site could mean the difference between life and death for a person having a heart attack. Local Red Cross chapters and the American Heart Association offer this type of training.
