Occupational safety is of paramount importance in our offices, warehouses, camps and worksites; safe working conditions promote job satisfaction while keeping workers on the job.
The people commonly assigned to deliver care are occupational first aid attendants Level III (OFAIII) who respond to medical emergencies on site. While having an OFAIII on site is the minimum standard, organizations serious about the safety of their workers can go above and beyond – as evidenced by the recent trend of placing experienced primary care paramedics (PCPs) and advanced care paramedics (ACPs) on site. Current WorkSafeBC regulations require high-risk worksites more than 20 minutes away from a hospital to be supported by an OFAIII with access to a first-aid room and transport vehicle. An OFAIII will perform to his or her scope of practice, but often an ill or injured patient will be referred elsewhere because the OFAIII does not have the training or authority to treat the patient beyond a basic level. When there is a life-threatening emergency, this is clearly necessary. However, when the injury is minor but nevertheless untreatable by the OFAIII, a productivity issue arises for employers, as the worker may not be able to return to work promptly, resulting in a lost-workday incident. Professionals providing medical care come with a variety of backgrounds and not all “medics” are created equal. The differences in the education and scope of an OFAIII, PCP and ACP are significant and clearly defined (see chart). Beyond the classroom, paramedics gain much of their experience working for an ambulance service and attending a wide spectrum of medical emergencies. These interactions provide them with practical experience to identify and treat cases they might find on the worksite.
| OFAIII | PCP | ACP | |
|---|---|---|---|
| Classroom Hours | 70 hours | 669 hours or six months | 1,765 hours or two years + previous PCP license |
| Scope of Practice | Primary assessment of injuries Identify circulatory injuries Identify head/ neck injuries | All OFAIII skills Administer cardiac and respiratory medications as needed Insert airway devices Initiate IVs | All OFAIII skills All PCP skills Cardiac monitoring Manage major traumas Administer pain management medications, including narcotics, as needed |
Under the supervision of a physician medical director, PCPs and ACPs can perform to the full scope of their license. A PCP can administer medications to ease the symptoms of common illnesses like asthma and diabetes. These interventions could save a time-consuming and costly transport out of camp. Likewise, an ACP has an even greater scope of care that extends to the use of narcotics for pain management and the ability to provide cardiac monitoring and airway management in the event of a life threatening emergency. Paramedics have the necessary skills to provide higher-level interventions before referring a patient to the hospital. In ongoing health and safety management, reducing lost-time injuries and major incidents is important to everyone. An efficient way to incorporate paramedics into the care model of remote work sites is through a “hub and spoke” response system. The highest trained responder (i.e., an ACP) is stationed at the main camp/ medical clinic, and is supported by a combination of PCPs and OFAIIIs strategically placed throughout the worksite to provide the appropriate level of care. Patients are treated on site and turned over to the
ACP as required. With such a system, the employer benefits from a high-value safety program while patients receive timely and appropriate care.
Employers looking to attract and retain top workers should consider expanding their health and safety program to include experienced ACPs and PCPs supported by a physician medical director. By raising the minimum standard of care, employers can take comfort in knowing their employees and contractors will receive the right care at the right time.
