Mind Your Head !
As part of the ongoing review into the uniform currently being worn by employees in our service, members of a small working party met at RAF Wattisham on 27 February 2019. The purpose of the visit was to observe crews of the Suffolk Fire & Rescue Service as they underwent practical refresher training in the extrication of persons from road traffic incidents. Those in attendance included David Sexby, Ajay Kumar, David Whitehouse and myself.
The Training Facility is located within the airfield and along with their administration building and classrooms they also have numerous scenarios staged at different locations which replicate incidents such as road traffic accidents and railways incidents. Each scenario is conducted under realistic conditions with actual cars, buses, trucks and railway carriages.
The fire crew responded to the incident which involved the driver of a car which had become trapped due to the front of the car being stuck under the rear section of a heavy goods vehicle and this enabled us to gain valuable insight into how the Fire Service deal with the hazards and how they protect their crews. Aside from the obvious risk of fire the crew was deployed to deal with gaining access, providing initial patient care and organising the extrication of the driver.
Lessons Learnt: When the fire crews are going about their extrication tasks, all equipment which is taken from their vehicles, is placed on a large heavy-duty sheet referred to as the Kit Dump. This is to ensure that no kit is left unattended or abandoned but always returned to a central location, ready for its next use on scene. I have long advocated that we should have a similar sheet on our ambulances, albeit smaller, so that our medical equipment is not contaminated or placed unserviceable due to being placed in mud or offensive matter.
We were also made aware of the by-products which become airborne during cutting operations, such as splinters, shards, particulates and carbon fibres. These can cause serious short-term and long-term harm, even life altering or fatal injuries; the very reason that we went to RAF Wattisham. We needed to know of the Personal Protection Equipment (PPE) that is issued to our ambulance crews is adequate, suitable and fit for purpose.
The Fire Service operate a two-level protection screen for the casualties and their crews. The first level is a hard, plastic teardrop screen which is designed to resist all hard and sharp objects resulting from their cutting operations. The second level is a heavy-duty blanket screen which is positioned between the teardrop and the casualty to “catch” any airborne material that is deflected from the teardrop. We noted that despite this two-level system that shards of glass and other latter was visible on the car seats and floor-pan; areas that ambulance crews might be expected to sit or kneel.
The PPE worm by the fire crews is designed to protect them when attending a wide range of emergency situations and this includes a helmet with integral visor, safety glasses, airway protection masks and heavy-duty gloves.
Lesson Learnt: When working in close proximity to the fire crews, do as they do. IF their risk assessment dictates that they must wear safety glasses and airway masks to protect themselves from minute airborne particulates or shards of flying glass, then we should do likewise.
The motor vehicle industry has progressed in leaps and bounds, design and research costing millions of pounds has gone into improving the safety of motor vehicle users and this has had a marked impact on the fire crews who have had to upgrade and improve their equipment and rescue techniques to deal with the hidden changes within vehicle bodywork construction. The once simple task of cutting A, B or C posts now requires stronger cutting tools and a different approach due to the strengthening of the vehicle framework.
Likewise, the once simple task of removing a patient trapped inside a motor vehicle is hampered by the hidden reinforcements and the additional by products of de-construction which are created by the rescue efforts of the fire crews. There is more to this that meets the eye, and we need to protect our eyes, airway and persons from harm. Following on from the day at RAF Wattisham we met again on 1 March at Newmarket Ambulance Station to collate our notes and to initiate a formal Risk Assessment on the PPE currently being worn by our ambulance crews.
The Head: We currently have two types of safety helmet in use, the Targa and the more recently added Pacific. Each has replaceable components and provides protection to the wearer.
The eyes: Integral visors provide a certain level of protection, but does the wearer need to wear separate safety glasses? If so, are there prescription safety glasses for those who wear prescription glasses as a matter of daily routine? Do the visors / safety glasses provide the correct level of protection from minute airborne particulates?
The ears: Helmets that have sides which cover the ears afford protection from wind and rain, but do they reduce the wearers ability to hear clearly what colleagues are saying? Are we able to use the stethoscope easily whilst wearing the helmet? Does the helmet cause problems to the wearer whilst inside a closed space such as a motor vehicle due to the bulkiness making contact with the vehicle interior, limiting the wearers head movement?
The airway: The helmets provide a very good level of protection to the head but little if any protection to the mouth and nose. During the majority of incidents when the helmet is being worn this is not an issue, but “when the fire crews don masks…” then perhaps we should too, but that requires the removal of the helmet in order to pass the mask straps over the head.
The aim of this document is to update ambulance employees on the progress that is being made by those involved in the improvement of our uniform which also includes our PPE. Radical changes do not and cannot happen overnight; it takes time. Step 1: raise the issue. Step 2: investigate the issue, what problems have arisen and what hazards require negating. Step 3: carry out a risk assessment and document your findings.There are numerous items of uniform clothing currently being worn and the group are working together in partnership to complete a full and thorough risk assessment so that any changes which need to be made can be fully justified, the rationale behind the changes can evidenced and the future design and or items can be secured knowing that their purchase and subsequent issue to employees has been made on solid evidence.
The group will continue with their work on your behalf. This is just one more step in the process.
East of England Ambulance Unison
4 March 2019